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Dunleavy S, Edelman DS, Wimer G, Karelas G, Hassan A, Clarke CD, Canfield SM, Lebwohl B, Lypson ML, Moise N. Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:635-643. [PMID: 38266203 DOI: 10.1097/acm.0000000000005646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multiyear, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. METHOD The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. RESULTS Across 3 cohorts, 405 of 420 (96.4%) students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty ( P < .001), more positive attitudes toward public health broadly ( P < .001), and increased knowledge of public health content ( P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. CONCLUSIONS Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.
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Jerotic S, Ignjatovic N, Maric NP, Nesic J, Jovandic Z, Latas M, Nestorovic M, Jevtovic M, Aftab A. A Comparative Study on Mental Disorder Conceptualization: A Cross-Disciplinary Analysis. Community Ment Health J 2024; 60:813-825. [PMID: 38319528 DOI: 10.1007/s10597-024-01240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
The conceptualization of mental disorders varies among professionals, impacting diagnosis, treatment, and research. This cross-disciplinary study aimed to understand how various professionals, including psychiatrists, psychologists, medical students, philosophers, and social sciences experts, perceive mental disorders, their attitudes towards the disease status of certain mental states, and their emphasis on biological versus social explanatory attributions. A survey of 371 participants assessed their agreement on a variety of conceptual statements and the relative influence of biological or social explanatory attribution for different mental states. Our findings revealed a consensus on the need for multiple explanatory perspectives in understanding psychiatric conditions and the influence of social, cultural, moral, and political values on diagnosis and classification. Psychiatrists demonstrated balanced bio-social explanatory attributions for various mental conditions, indicating a potential shift from the biological attribution predominantly observed among medical students and residents in psychiatry. Further research into factors influencing these differing perspectives is necessary.
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Affiliation(s)
- Stefan Jerotic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia.
| | - Natalija Ignjatovic
- Faculty of Philosophy, Department of Psychology, University of Belgrade, Belgrade, Serbia
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Janko Nesic
- Institute of Social Sciences, Belgrade, Serbia
| | | | - Milan Latas
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Milica Nestorovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Milica Jevtovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, US
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Ventres WB, Stone LA, Shah R, Carter T, Gusoff GM, Liaw W, Nguyen BM, Rachelson JV, Scott MA, Schiff-Elfalan TL, Yamada S, Like RC, Zoppi K, Catinella AP, Frankel RM, Prasad S. Storylines of family medicine II: foundational building blocks-context, community and health. Fam Med Community Health 2024; 12:e002789. [PMID: 38609084 PMCID: PMC11029393 DOI: 10.1136/fmch-2024-002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'II: foundational building blocks-context, community and health', authors address the following themes: 'Context-grounding family medicine in time, place and being', 'Recentring community', 'Community-oriented primary care', 'Embeddedness in practice', 'The meaning of health', 'Disease, illness and sickness-core concepts', 'The biopsychosocial model', 'The biopsychosocial approach' and 'Family medicine as social medicine.' May readers grasp new implications for medical education and practice in these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | | | - Tamala Carter
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Geoffrey M Gusoff
- National Clinician Scholars Program, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Winston Liaw
- Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Bich-May Nguyen
- Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Joanna V Rachelson
- Southern New Mexico Family Medicine Residency Program, Las Cruces, New Mexico, USA
| | - Mary Alice Scott
- New Mexico Primary Care Training Program, Silver City, New Mexico, USA
- Anthropology, New Mexico State University, Las Cruces, New Mexico, USA
| | - Teresa L Schiff-Elfalan
- Family Medicine and Community Health, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Seiji Yamada
- Family Medicine and Community Health, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Robert C Like
- Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathleen Zoppi
- Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - A Peter Catinella
- Family Medicine - Transmountain, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Richard M Frankel
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shailendra Prasad
- Family Medicine and Community Health, University of Minnesota Medical School - Twin Cities Campus, Minneapolis, Minnesota, USA
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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. MEDICAL TEACHER 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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Balhara KS, Regan L, Chopra E, Irvin N. Bringing abstract concepts to life: A health humanities-based approach to teaching social determinants of health. AEM EDUCATION AND TRAINING 2024; 8:e10934. [PMID: 38510731 PMCID: PMC10950014 DOI: 10.1002/aet2.10934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 03/22/2024]
Abstract
Background To address health inequities, emergency physicians must understand the structural underpinnings of health disparities, including social determinants of health (SDoH), and must critically reflect on the integration of SDoH into clinical practice. SDoH education should include reflective knowledge acquisition, while incorporating systemic sociohistorical forces and individual factors, such as bias, which propagate inequities but are rarely emphasized in graduate medical education (GME). The health humanities (HH), an inclusive transdisciplinary field combining arts, humanities, and social justice, may represent a novel unexplored approach toward incorporating SDoH in GME. Methods We sought to implement and evaluate a GME HH-based curriculum focused on SDoH. An interprofessional team applied Kern's framework to create a longitudinal HH curriculum integrating narrative medicine and visual thinking strategies with evidence-based practices for addressing SDoH in clinical practice. This curriculum was implemented for 52 residents in an EM program in 2019-2020; sessions were initially held in the classroom and community and then virtually during the COVID-19 pandemic. Objectives included encouraging (1) critical thinking about SDoH, (2) engagement with patients and communities, (3) self-reflection, and (4) translation of SDoH to patient care. Descriptive statistics and a constructivist paradigm were applied to results of a postcurriculum survey and focus group, respectively. Results A curriculum evaluation survey completed by 32/52 residents (61.5%) revealed agreement (75%-90%) that objectives were met. 93.1% of respondents thought humanities were important in residency training. Qualitative analysis of a focus group with 10 participants revealed additional impacts on individual growth, transformation of departmental culture, and transformation of patient care. Curriculum implementation was inexpensive and relied on interprofessional collaboration. Conclusions The HH represent a promising collaborative framework for integrating SDoH in GME and may inspire transformation of learners' attitudes and practices in EM, though clinical impacts still need to be established.
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Affiliation(s)
- Kamna S. Balhara
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Eisha Chopra
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Present address:
Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Nathan Irvin
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Laird-Gion JN, Garabedian LF, Conrad R, Shaffer AC, Witkowski ML, Mateo CM, Jones DS, Hundert E, Kasper J. "The Water in Which We Swim:" A Unique, Post-Clerkship Multidisciplinary Course. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241232184. [PMID: 38390256 PMCID: PMC10883117 DOI: 10.1177/23821205241232184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum. METHODS In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses-"Essentials of the Profession I and II"-to fill this gap. "Essentials of the Profession II (EOP2)" is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders. RESULTS Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures. CONCLUSIONS We argue that EOP2 is "essential" for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.
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Affiliation(s)
- Jessica N Laird-Gion
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura F Garabedian
- Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Rachel Conrad
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam C Shaffer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary L Witkowski
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Camila M Mateo
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - David S Jones
- Harvard Medical School, Boston, MA, USA
- Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
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Homa F, Jacqueline R, Christophe B. Moving towards social dentistry: How do dentists perceive the Montreal-Toulouse model? Community Dent Oral Epidemiol 2023; 51:1187-1196. [PMID: 37042424 DOI: 10.1111/cdoe.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/25/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES This study aimed to understand the perspectives of dentists towards the Montreal-Toulouse model, an innovative approach that encompasses person-centredness and social dentistry. This model invites dentists to take three types of actions (understanding, decision-making, intervening) on three overlapping levels (individual, community, societal). This study aimed to understand (a) How dentists perceived the Montreal-Toulouse model as a framework for the practice of dentistry and (b) What parts of this model they were ready to adopt in their own practice. METHODS A qualitative descriptive study was conducted based on semi-structured interviews with a sample of dentists in the Province of Quebec, Canada. A combination of maximum variation and snowball sampling strategies was employed and 14 information-rich participants were recruited. The interviews were conducted and audio-recorded through Zoom and lasted approximately 1 h and a half. The interviews were transcribed verbatim and thematically analysed through a combination of inductive and deductive coding. RESULTS The participants explained they valued person-centred care and tried to put the individual level of the Montreal-Toulouse model into practice. However, they expressed little interest in the social dentistry aspects of the model. They acknowledged not knowing how to organize and conduct upstream interventions and were not comfortable with social and political activism. According to them, advocating for better health-related policies, while a noble act, 'was not their job'. They also highlighted the structural challenges that dentists face in fostering biopsychosocial approaches such as the Montreal-Toulouse model. CONCLUSIONS To promote the Montreal-Toulouse model and empower dentists to address social determinants of health, an educational and organizational 'paradigm shift' towards social accountability might be necessary. Such a shift requires curricular modifications and reconsidering traditional teaching approaches in dental schools. Moreover, dentistry's professional organization could facilitate dentists' upstream actions through proper resource allocation and openness to collaboration with them.
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Affiliation(s)
- Fathi Homa
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Rousseau Jacqueline
- École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Canada
| | - Bedos Christophe
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
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Peebles ER, Pack R, Goldszmidt M. From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice. MEDICAL EDUCATION 2023; 57:1054-1067. [PMID: 37621235 DOI: 10.1111/medu.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. METHODS We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician-written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. RESULTS We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor-patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. CONCLUSIONS Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice.
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Affiliation(s)
- Erin R Peebles
- Division of General Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, ON, Canada
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Collins B, Jones N. Digital Simulacra: Circumventing Diversity and Inclusion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:76-78. [PMID: 37647473 DOI: 10.1080/15265161.2023.2237430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
| | - Nora Jones
- Lewis Katz School of Medicine at Temple University
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12
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Burm S, Cristancho S, Watling CJ, LaDonna KA. Expanding the advocacy lens: using photo-elicitation to capture patients' and physicians' perspectives about health advocacy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:411-426. [PMID: 36214940 DOI: 10.1007/s10459-022-10162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/03/2022] [Indexed: 05/11/2023]
Abstract
Heath advocacy (HA) remains a difficult competency to train and assess, in part because practicing physicians and learners carry uncertainty about what HA means and we are missing patients' perspectives about the role HA plays in their care. Visual methods are useful tools for exploring nebulous topics in health professions education; using these participatory approaches with physicians and patients might counteract the identified training challenges around HA and more importantly, remedy the exclusion of patient perspectives. In this paper we share the verbal and visual reflections of patients and physicians regarding their conceptualizations of, and engagement in 'everyday' advocacy. In doing so, we reveal some of HA's hidden dimensions and what their images uncovered about the role of advocacy in patient care. Constructivist grounded theory guided data collection and analysis. Data was collected through semi-structured interviews and photo-elicitation, a visual research method that uses participant generated photographs to elicit participants knowledge and experiences around a particular topic. We invited patients living with chronic health conditions (n = 10) and physicians from diverse medical and surgical specialties (n = 14) to self-select photographs representing their experiences navigating HA in their personal and professional lives. Both groups found taking photographs useful for revealing the nuanced and circumstantial factors that either enabled or challenged their engagement in HA. While patients' photos highlighted their embodiment of HA, physicians' photos depicted HA as something quite elusive or as a complicated and daunting task. Photo-elicitation was a powerful tool in eliciting a diversity of perspectives that exist around the HA role and the work advocates perform; training programs might consider using visuals to augment teaching for this challenging competency.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development and Division of Medical Education, Clinical Research Centre, C-104, Dalhousie University, 5849 University Ave, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Sayra Cristancho
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Vongsachang H, Schneberk T, Sprunt L, Padilla G, Riddell J. The Impact of an Experiential Social Medicine Curriculum in an Emergency Medicine Residency Training Program: Mixed-methods Curricular Evaluation. West J Emerg Med 2023; 24:83-88. [PMID: 36602495 PMCID: PMC9897255 DOI: 10.5811/westjem.2022.10.57724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hurnan Vongsachang
- Los Angeles County + University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Todd Schneberk
- Los Angeles County + University of Southern California Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Laura Sprunt
- Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Gabe Padilla
- Rhode Island Hospital and Brown Emergency Medicine Residency, Providence, Rhode Island
| | - Jeff Riddell
- Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California
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Caretta‐Weyer HA, Hess JM. Bridging the gap: Development of an experiential learning-based health disparities curriculum. AEM EDUCATION AND TRAINING 2022; 6:e10820. [PMID: 36518232 PMCID: PMC9731307 DOI: 10.1002/aet2.10820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The increasing number of vulnerable populations served by the emergency department (ED) calls for developing and implementing curricula aimed at training residents to deliver quality care for the most marginalized groups. OBJECTIVE We aimed to address this by developing and piloting a curriculum to introduce the unique challenges and disparities encountered by our diverse ED patient population using an experiential learning approach. METHODS We engaged community partners in designing and implementing a curriculum for incoming interns. This curriculum addresses specific populations encountered within the ED including patients with psychiatric illness, patients with cognitive disabilities, intoxicated patients, violent patients, patients of various cultural backgrounds, non-English-speaking patients, and LGBTQ patients. Experiential and active learning sessions with content experts and site visits to area organizations were arranged. Pre-, post-, and time-delayed surveys were deployed to evaluate the pilot of this curriculum. RESULTS Thirteen incoming interns participated in the orientation curriculum. Residents' comfort with each of these various patient populations as well as familiarity with community and ED resources was assessed before, after, and 1 year delayed from each session (response 13/13, 100%). Their scores increased significantly from baseline in the postsurvey and were maintained 1 year later (p < 0.05). Residents additionally provided narrative responses regarding what they learned and what was most helpful after completing their intern year. CONCLUSIONS This pilot curriculum demonstrates that implementing an experiential learning curriculum and engaging community leaders and resources is key to training residents to address health disparities within their unique ED patient population. As such, it is imperative that we seek to immersively introduce trainees to the unique needs of the patient population they will serve early in training.
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Affiliation(s)
- Holly A. Caretta‐Weyer
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Jamie M. Hess
- Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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15
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Fathi H, Rousseau J, Bedos C. How do dentists perceive portable dentistry? A qualitative study conducted in Quebec. Gerodontology 2022; 40:231-237. [PMID: 35833357 DOI: 10.1111/ger.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/03/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION People with impaired mobility face difficulty accessing dental care. One solution is portable dentistry, which includes delivering dental care in homes or residential institutions. Dentists, however, appear reluctant to offer such services. Our objective was to understand how dentists perceived portable dentistry and potential challenges to its implementation. METHODS We conducted a qualitative descriptive study based on semi-structured interviews with a sample of dentists in Quebec, Canada. We employed a combination of maximum variation and snowball sampling strategies to recruit 14 participants. The interviews were conducted and audio-recorded through Zoom and lasted approximately 40 minutes. After transcribing them, we performed a thematic analysis with a combination of inductive and deductive coding. RESULTS Despite perceiving portable dentistry as a valuable practice model, participants showed little interest in adopting this approach, arguing it was not every dentist's "job" to provide portable services. They believed portable dentistry must be financially burdensome and difficult to integrate into their daily work due to lack of time and portable equipment. Accordingly, participants considered it was the duty of governments, professional organisations overseeing dentistry education and practice, and dental schools to develop portable dentistry programs and hire dentists to deliver such services. CONCLUSIONS To promote portable dentistry, it may be necessary to improve the knowledge and competencies of dentists, but also to challenge their professional identity as well as the current model of dental clinics as the standard of care delivery. To achieve this, we need strong leadership from dental schools, professional organisations and government.
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Affiliation(s)
- Homa Fathi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Christophe Bedos
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
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16
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Del Buono BC, Salhi BA, Kimmel AE, Santen SA, Jarrell KL, White MH, Brown CK, Moll JL. Prioritizing homelessness in emergency medicine education: A concept paper. AEM EDUCATION AND TRAINING 2022; 6:S85-S92. [PMID: 35774356 PMCID: PMC9222893 DOI: 10.1002/aet2.10753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experiencing homelessness visit the emergency department (ED) often and have worse clinical outcomes. Caring for this patient population is complex, challenging, and resource-intensive. Emergency medicine (EM) education is lacking in formal curricula on the topic of homelessness, despite benefits for resident morale and patient care. Our goals were to identify a gap in EM education and training of the intersection of housing and health and propose educational topics and teaching methods to be included in residency curricula. Methodology was based on the development of a didactic session at the 2021 SAEM Annual Meeting. A needs assessment was performed through a review of medical education literature, a national survey of EM residency curricula, the individual curricula utilized by respective team members, and perspective from the team's own individual experiences with teaching about homelessness. Topics presented were chosen through discussion between the authors and determined to be common and relevant and cover a broad spectrum of content. The four presented topics included the intersection of COVID-19 and housing, the impact of LGBTQIA+ status on homelessness, housing status related to health system utilization and health outcomes, and housing inequity as a means of perpetuating structural racism. Suggestions for education of these topics included case-based learning, journal clubs, simulation, collaboration with social work, quality improvement projects, and engagement with community leaders. The ED is uniquely positioned to encounter the impacts of homelessness on health. Emergency physicians should be prepared to effectively care for these patients with complex social needs. Structured learning on this topic would benefit EM resident growth and lead to better patient care through improved screening, recognition of risk factors, and use of social resources.
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Affiliation(s)
- Benedict C. Del Buono
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Bisan A. Salhi
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alexis E. Kimmel
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sally A. Santen
- Virginia Commonwealth University School of MedicineProfessor, Emergency Medicine and Medical EducationUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kelli L. Jarrell
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christopher K. Brown
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Joel L. Moll
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Voller VK, Olirus Owilli A, Yang AX, Finnegan AC, Westerhaus M. Evaluating the impact of a social medicine course delivered in a local‐global context: A 10‐year multi‐site analysis. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Vanessa K. Voller
- Organizational Leadership Policy and Development, College of Education and Human Development and School of Public Health The University of Minnesota Minneapolis Minnesota USA
| | - Alex Olirus Owilli
- Department of Community Health and Epidemiology The University of Saskatchewan Saskatoon Saskatchewan Canada
- Equal Health Inc. Brookline Massachusetts USA
| | - Andrew X. Yang
- Mayo Clinic Alix School of Medicine, Mayo Clinic Rochester Minnesota USA
| | - Amy C. Finnegan
- Equal Health Inc. Brookline Massachusetts USA
- Department of Justice and Peace Studies University of St. Thomas St. Paul Minnesota USA
| | - Michael Westerhaus
- Equal Health Inc. Brookline Massachusetts USA
- Department of Global Medicine, School of Medicine The University of Minnesota Minneapolis Minnesota USA
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18
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Olirus Owilli A, Voller VK, Martin W, Compton RM, Westerhaus M. Beyond witnesses: Moving health workers towards analysis and action on social determinants of health. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alex Olirus Owilli
- Department of Community Health and Epidemiology, College of Medicine The University of Saskatchewan Saskatoon Saskatchewan Canada
- EqualHealth Inc. Brookline Massachusetts USA
| | - Vanessa K. Voller
- College of Education and Human Development and School of Public Health The University of Minnesota Minneapolis Minnesota USA
| | - Wanda Martin
- College of Nursing The University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Roslyn M. Compton
- College of Nursing The University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Michael Westerhaus
- EqualHealth Inc. Brookline Massachusetts USA
- Global Health Pathway, The Center for International Health, School of Medicine University of Minnesota Minneapolis Minnesota USA
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Fairman KA. Pandemics, Policy, and the Power of Paradigm: Will COVID-19 Lead to a New Scientific Revolution? Ann Epidemiol 2022; 69:17-23. [PMID: 35231588 PMCID: PMC8882036 DOI: 10.1016/j.annepidem.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/02/2022]
Abstract
Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S. public health science and policy beginning in the 20th century. This paradigm was reflected in federal government reliance on infectious disease physicians as the primary scientific decision makers in the COVID-19 pandemic. Similarly, epistemic conflict over challenges to behavioral and social well-being in 2020 may highlight discordance between the dominant biomedical paradigm used in making federal policy and the inherently holistic impact of that policy on population health, suggesting need for a new paradigm of multidisciplinary scientific engagement. Because population-wide public health initiatives affect many aspects of health—physiological, psychological, behavioral, and social—that are best measured and interpreted by experts in these respective fields, multidisciplinary scientific engagement would facilitate optimal, holistic evaluation of policy benefits and harms. This multidisciplinary approach, analogous to that currently recommended in medical management of chronic disease, would advance epidemiological research to inform evidence-based policy for public health crises in which U.S. population-wide interventions are contemplated.
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Sukhera J, Knaak S, Ungar T, Rehman M. Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:175-181. [PMID: 34647920 DOI: 10.1097/acm.0000000000004451] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.
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Affiliation(s)
- Javeed Sukhera
- J. Sukhera is chair of psychiatry, Institute of Living, and chief of psychiatry, Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Stephanie Knaak
- S. Knaak is research consultant, Mental Health Commission of Canada, and assistant professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-7663-3451
| | - Thomas Ungar
- T. Ungar is psychiatrist in chief, St. Michael's Hospital, Unity Health Toronto, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-9627-0421
| | - Maham Rehman
- M. Rehman is research associate, Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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21
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Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1505-1514. [PMID: 34988614 PMCID: PMC9246797 DOI: 10.1007/s00127-021-02197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022]
Abstract
Purpose Rehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students’ knowledge changes after social medicine training. Methods This quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons. Results All groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities. Conclusions Social medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups’ knowledge levels.
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22
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Miyachi J, Iida J, Shimazono Y, Nishigori H. A collaborative clinical case conference model for teaching social and behavioral science in medicine: an action research study. BMC MEDICAL EDUCATION 2021; 21:574. [PMID: 34772406 PMCID: PMC8590366 DOI: 10.1186/s12909-021-03009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Effective social and behavioral sciences teaching in medical education requires integration with clinical experience, as well as collaboration between social and behavioral sciences experts and clinical faculty. However, teaching models for achieving this integration have not been adequately established, nor has the collaboration process been described. This study aims to propose a collaborative clinical case conference model to integrate social and behavioral sciences and clinical experience. Additionally, we describe how social and behavioral science experts and clinical faculty collaborate during the development of the teaching method. METHODS A team of medical teachers and medical anthropologists planned for the development of a case conference based on action research methodology. The initial model was planned for a 3-h session, similar to a Clinicopathological Conference (CPC) structure. We evaluated each session based on field notes taken by medical anthropologists and post-session questionnaires that surveyed participants' reactions and points of improvement. Based on the evaluation, a reflective meeting was held to discuss revisions for the next trial. We incorporated the development process into undergraduate medical curricula in clinical years and in a postgraduate and continuous professional development session for residents and certified family physicians in Japan. We repeated the plan-act-observe-reflection process more than 15 times between 2015 and 2018. RESULTS The development of the collaborative clinical case conference model is summarized in three phases: Quasi-CPC, Interactive, and Co-constructive with unique structures and underlying paradigms. The model successfully contributed to promoting the participants' recognition of the clinical significance of social and behavioral sciences. The case preparation entailed unique and significant learning of how social and behavioral sciences inform clinical practice. The model development process promoted the mutual understanding between clinical faculty and anthropologists, which might function as faculty development for teachers involved in social and behavioral sciences teaching in medical education. CONCLUSIONS The application of appropriate conference models and awareness of their underlying paradigms according to educational situations promotes the integration of social and behavioral sciences with clinical medicine education. Faculty development regarding social and behavioral sciences in medical education should focus on collaboration with scholars with different paradigmatic orientations.
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Affiliation(s)
- Junichiro Miyachi
- Center for Medical Education, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho Showa-ku Nagoya, Nagoya, Aichi, 466-8560, Japan.
- Azai-Higashi Clinic, Hokkaido Centre for Family Medicine, Sapporo, Hokkaido, Japan.
- Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Junko Iida
- Faculty of Health and Welfare, Kawasaki University of Medical Welfare, Okayama, Japan
| | | | - Hiroshi Nishigori
- Center for Medical Education, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho Showa-ku Nagoya, Nagoya, Aichi, 466-8560, Japan
- Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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Chang RS, Kloosterman N, Ukwuani S, Carpenter HL, Miller B. The Social Mission Committee: Establishing a Student-Based Organization to Advance Awareness of Socially Conscious Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S179-S180. [PMID: 34705677 DOI: 10.1097/acm.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Rachel S Chang
- Author affiliations: R.S. Chang, N. Kloosterman, S. Ukwuani, H.L. Carpenter, B. Miller, Vanderbilt University School of Medicine
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Papadopulos JS, Mentis AFA, Liapi C. Social Pharmacology as an Underappreciated Field in Medical Education: A Single Medical School's Experience. Front Pharmacol 2021; 12:714707. [PMID: 34531746 PMCID: PMC8438604 DOI: 10.3389/fphar.2021.714707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Alexios-Fotios A Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Liapi
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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25
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Singh MK, Gullett HL, Thomas PA. Using Kern's 6-Step Approach to Integrate Health Systems Science Curricula Into Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1282-1290. [PMID: 33951679 DOI: 10.1097/acm.0000000000004141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.
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Affiliation(s)
- Mamta K Singh
- M.K. Singh is professor of medicine, Jerome Kowal, MD Designated Professor for Geriatric Health Education, Veterans Affairs Northeast Ohio Healthcare System, and former assistant dean, Health Systems Science, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8235-4272
| | - Heidi L Gullett
- H.L. Gullett is associate professor and Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine, Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-3984-517X
| | - Patricia A Thomas
- P.A. Thomas was, when this was written, professor of medicine, Amasa B. Ford Professor of Geriatrics, and vice dean, Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio; she is currently professor of medicine emerita, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-4528-9891
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Finnie SM, Brach RJ, Dawson CA, Epstein SB, Goyal RK, Lounsbury KM, Eldakar-Hein ST, Lahey T. A new roadmap for social medicine curriculum design based on mixed methods student and faculty evaluations of the preclinical curriculum. BMC MEDICAL EDUCATION 2021; 21:442. [PMID: 34416885 PMCID: PMC8376629 DOI: 10.1186/s12909-021-02885-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To support the development of social medicine curricula that empower medical school graduates to redress health inequities, we conducted a mixed methods student and faculty evaluation of an expanded and innovative preclinical social medicine curriculum. METHODS We implemented a longitudinal, interactive preclinical social medicine curriculum that was closely integrated with foundational science teaching then conducted a survey-based mixed methods student and faculty curriculum evaluation. Based on these results, we propose a novel conceptual roadmap for social medicine curriculum design. RESULTS Student and faculty evaluations of an expanded and innovative longitudinal preclinical social medicine curriculum were strongly favorable. Both student and faculty respondents indicated a particular desire for deeper coverage of race and poverty among other social medicine domains. Qualitative student evaluations highlighted the importance of faculty champions to social medicine teaching as well as the educational impact of stories that exemplify the practical impact of the social determinants of health on specific patient experiences. Qualitative faculty evaluations pointed to the challenges of curriculum integration and the need for faculty career development in social medicine teaching. CONCLUSIONS Based on mixed methods student and faculty curriculum evaluation data, we propose a novel conceptual roadmap for the design of social medicine curricula at other institutions.
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Affiliation(s)
- Sheridan M Finnie
- From the Class of 2022, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Richard J Brach
- From the Class of 2022, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Christina A Dawson
- Class of 2021, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Samuel B Epstein
- Class of 2021, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Raghav K Goyal
- Class of 2021, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Karen M Lounsbury
- The Office of Medical Student Education, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Shaden T Eldakar-Hein
- The Office of Medical Student Education, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Timothy Lahey
- Department of Medicine/Ethics, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT, 05405, USA.
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Chimonas S, Mamoor M, Kaltenboeck A, Korenstein D. The future of physician advocacy: a survey of U.S. medical students. BMC MEDICAL EDUCATION 2021; 21:399. [PMID: 34303349 PMCID: PMC8310411 DOI: 10.1186/s12909-021-02830-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/14/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Advocacy is a core component of medical professionalism. It is unclear how educators can best prepare trainees for this professional obligation. We sought to assess medical students' attitudes toward advocacy, including activities and issues of interest, and to determine congruence with professional obligations. METHODS A cross-sectional, web-based survey probed U.S. medical students' attitudes around 7 medical issues (e.g. nutrition/obesity, addiction) and 11 determinants of health (e.g. housing, transportation). Descriptive statistics, Kruskal-Wallis tests, and regression analysis investigated associations with demographic characteristics. RESULTS Of 240 students completing the survey, 53% were female; most were white (62%) or Asian (28%). Most agreed it is very important that physicians encourage medical organizations to advocate for public health (76%) and provide health-related expertise to the community (57%). More participants rated advocacy for medical issues as very important, compared to issues with indirect connections to health (p < 0.001). Generally, liberals and non-whites were likelier than others to value advocacy. CONCLUSIONS Medical students reported strong interest in advocacy, particularly around health issues, consistent with professional standards. Many attitudes were associated with political affiliation and race. To optimize future physician advocacy, educators should provide opportunities for learning and engagement in issues of interest.
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Affiliation(s)
- Susan Chimonas
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA.
| | - Maha Mamoor
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Anna Kaltenboeck
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Deborah Korenstein
- Center for Health Policy & Outcomes and chief of the General Internal Medicine Service at Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tsai J, Lindo E, Bridges K. Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short. Front Public Health 2021; 9:653643. [PMID: 34327185 PMCID: PMC8313803 DOI: 10.3389/fpubh.2021.653643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
A professional and moral medical education should equip trainees with the knowledge and skills necessary to effectively advance health equity. In this Perspective, we argue that critical theoretical frameworks should be taught to physicians so they can interrogate structural sources of racial inequities and achieve this goal. We begin by elucidating the shortcomings in the pedagogic approaches contemporary Biomedical and Social Determinants of Health (SDOH) curricula use in their discussion of health disparities. In particular, current medical pedagogy lacks self-reflexivity; encodes social identities like race and gender as essential risk factors; neglects to examine root causes of health inequity; and fails to teach learners how to challenge injustice. In contrast, we argue that Critical Race Theory (CRT) is a theoretical framework uniquely adept at addressing these concerns. It offers needed interdisciplinary perspectives that teach learners how to abolish biological racism; leverage historical contexts of oppression to inform interventions; center the scholarship of the marginalized; and understand the institutional mechanisms and ubiquity of racism. In sum, CRT does what biomedical and SDOH curricula cannot: rigorously teach physician trainees how to combat health inequity. In this essay, we demonstrate how the theoretical paradigms operationalized in discussions of health injustice affect the ability of learners to confront health inequity. We expound on CRT tenets, discuss their application to medical pedagogy, and provide an in-depth case study to ground our major argument that theory matters. We introduce MedCRT: a CRT-based framework for medical education, and advocate for its implementation into physician training.
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Affiliation(s)
- Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Edwin Lindo
- Office of Healthcare Equity, University of Washington School of Medicine, Seattle, WA, United States
| | - Khiara Bridges
- University of California, Berkeley School of Law, Berkeley, CA, United States
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Deng M, Nham E, Malvea A, Ramsay T, Seabrook C, Watterson J. Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation. JOURNAL OF SURGICAL EDUCATION 2021; 78:1236-1249. [PMID: 33293258 DOI: 10.1016/j.jsurg.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties. DESIGN In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016). SETTING Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada. PARTICIPANTS Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female). RESULTS Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11). CONCLUSIONS Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.
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Affiliation(s)
- Mimi Deng
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Emily Nham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anahita Malvea
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Seabrook
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - James Watterson
- Department of Surgery, Eric C. Poulin Office of Surgical Education at University of Ottawa, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital - General Campus, Ottawa, Ontario, Canada
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Takamura A, Imafuku R. What is the impact of the Rashomon approach in primary care education?: An educational case report of implementing dialogue and improvisation into medical education. BMC MEDICAL EDUCATION 2021; 21:143. [PMID: 33663483 PMCID: PMC7934433 DOI: 10.1186/s12909-021-02570-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The excessive sub-divided or concrete pre-determined objectives found in the technological approach in contemporary medical education curricula may hinder the students' spontaneous learning about diverse needs and values in care. However, medical professionals must learn the diversity for care or a variety of social factors of the patients influencing decision making in daily practice. METHODS We introduced a new method of curriculum development called the Rashomon approach. For testing the Rashomon approach, educational activities to teach the diversity in primary care were developed in four modules: 1) explication of the competency without specifying sub-objectives; 2) dialogue among multiple professional students; 3) visits and interviews of the patients; 4) dialogue with teachers' improvisation. The students' outcomes and responses were quantitatively and qualitatively analyzed. RESULTS A total of 135 medical students joined this study in 2017. The descriptive data suggested that the key concepts of diversity in primary care were fully recognized and that the pre-determined general goals were achieved. Scores on the understanding of social factors in medicine, respect for other professionals, professional identity, and satisfaction with the course were very high. CONCLUSION Instead of the technological approach, the Rashomon approach, in which only a general goal guides educational activities was used in this research. Improvisation and dialogue fit the approach and were potentially effective activities to learn the multifaceted practice of medicine. In an era of competency-based education, the Rashomon approach could be a very useful framework in primary care education.
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Affiliation(s)
- Akiteru Takamura
- Department of Medical Education, Kanazawa Medical University, 1-1 Uchinada-machi Daigaku, Kahoku-gun, Kanazawa, Ishikawa, 920-0293, Japan.
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University, Gifu, Japan
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Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19. J Am Med Dir Assoc 2021; 22:504-509. [PMID: 33189565 PMCID: PMC7522703 DOI: 10.1016/j.jamda.2020.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe long-term care services and supports (LTSS) in the United States, note their limitations in serving older adults post-incarceration, and offer potential solutions, with special consideration for the Coronavirus Disease 2019 pandemic. DESIGN Narrative review. SETTING AND PARTICIPANTS LTSS for older adults post-incarceration. METHODS Literature review and policy analysis. RESULTS Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison. CONCLUSIONS AND IMPLICATIONS Long-standing gaps in US LTSS are revealed by the coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults after incarceration.
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Tsai J. Building Structural Empathy to Marshal Critical Education into Compassionate Practice: Evaluation of a Medical School Critical Race Theory Course. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:211-221. [PMID: 34924057 DOI: 10.1017/jme.2021.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ideas of racial genetic determinism, though unsupported by scientific evidence and atavistic, are common and readily apparent in American medical education. These theories of biologic essentialism have documented negative effects in learners, including increased measures of racial prejudice.
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Garg M, Eniasivam A, Satterfield J, Norton B, Austin E, Dohan D. Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus. MEDICAL EDUCATION ONLINE 2020; 25:1812225. [PMID: 32822280 PMCID: PMC7482827 DOI: 10.1080/10872981.2020.1812225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 06/01/2023]
Abstract
As the coronavirus pandemic started, we rapidly transitioned a preclinical social justice and health systems sciences course at our medical school to asynchronous, remote learning. We describe processes, curricular innovations, and lessons learned. Small groups were converted into independent learning modules and lectures were given live via videoconferencing technology. We started with a simplified approach and then built technological capabilities over time. Current events were incorporated into curriculum and assessment. Our course ran from 16 March-3 April 2020 for the 155-person first-year class. Student attendance for optional, synchronous remote sessions was higher than in-person attendance in previous years. Completion rates for assignments were high but with minimal student collaboration. Faculty office hours were underutilized. Focus group and formal evaluations were largely positive, with numerical ratings for quality of the course and faculty teaching higher than the 2 years prior. Student engagement with social justice topics in aremote format was successful through modifications to small groups and lecture structure. Students, faculty, and administrative staff appreciated the consistency of session format throughout the course. Students exam performance was similar to prior years. Attention should be paid to what can be learned via self-study as opposed to small group learning. Better methods of soliciting real-time student feedback, and encouraging engagement with each other and with faculty in aremote environment are needed.
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Affiliation(s)
- Megha Garg
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Archna Eniasivam
- Departments of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Jason Satterfield
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Betsy Norton
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Austin
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
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Kiles T, Jasmin H, Nichols B, Haddad R, Renfro CP. A Scoping Review of Active-Learning Strategies for Teaching Social Determinants of Health in Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:8241. [PMID: 34283757 PMCID: PMC7712738 DOI: 10.5688/ajpe8241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 05/10/2023]
Abstract
Objective. To review current conceptualizations and measurements of active-learning education within Doctor of Pharmacy degree programs as it pertains to social determinants of health (SDOH) and to determine the gaps and limitations in available literature. A secondary objective was to assess simulation-based educational methods related to SDOH in pharmacy.Findings. Sixteen articles were eligible for inclusion. Many simulation-based and non-simulation-based teaching strategies are described. The majority of articles included active-learning activities related to social/community context and health/health care, the other three 3 social determinants of health domains: education, economic stability, and neighborhood/built community, were not equally addressed. In the studies included in this review, schools and colleges of pharmacy did not appear to not be integrating all five components of SDOH into active learning curricula. The sparsity of literature and lack of diversity in published types of simulated experiences and assessments may suggest there is room for innovation in this area.Summary. More research is needed in order to fully characterize conceptualizations of social determinants of health in Doctor of Pharmacy degree programs in order to ensure students are provided with a full understanding of the SDOH factors that affect patient outcomes.
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Affiliation(s)
- Tyler Kiles
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Hilary Jasmin
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Brittany Nichols
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Romena Haddad
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Chelsea P Renfro
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
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Loyola AB, Palileo-Villanueva LM. A Role-Playing Activity for Medical Students Demonstrates Economic Factors Affecting Health in Underprivileged Communities. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:637-644. [PMID: 32982536 PMCID: PMC7489936 DOI: 10.2147/amep.s259032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Innovative teaching-learning strategies are necessary to promote community orientation and foster awareness of the social determinants of health among millennial learners in the health professions. METHODS The authors designed a role-playing simulation activity that aims to highlight the multidimensional nature of health and develop in students an appreciation of the day-to-day experiences of underserved populations. The current investigation aimed to evaluate the utility of the role-playing activity and guided reflection in terms of the students' appreciation of economic factors that affect health and health-seeking behavior of patients and their recognition of the role of healthcare professionals with respect to issues related to poverty and health. Thematic analyses of the insights and observations of the students immediately after the activity and the anonymized reflection papers were done to identify recurring ideas that made an impression on them. RESULTS The students were able to identify that in a setting with limited employment opportunities and low-income potential, the residents prioritized food and shelter over everything else. They also chose cheaper products over healthier options. Practically everyone forewent out-of-pocket healthcare expenditure in order to minimize its disruptive consequences. In these settings, the students highlighted the role of society and government in the provision of services and in community development. The students also emphasized the necessity for competition among a number of providers of goods and services to reduce prices. When asked if healthcare professionals are contributing to the widening gap between rich and poor, 70% agreed, 9% disagreed, 14% did not give a direct answer, and 7% said that healthcare professionals contributed in some ways and alleviated in other ways. The most commonly cited behavior that contribute to this disparity are the decision to seek highly specialized training, the congregation of practitioners in highly urbanized centers, and inattention to the economic difficulties of most patients. Those who disagreed with the statement cited systemic problems as the driving force that widens the disparity. In particular, these students cited the commodification of healthcare and related services, inappropriate policies, and insufficient funding specifically for services and health human resources. CONCLUSION The evolving landscape in healthcare financing requires more preparation among our medical students and trainees. Innovative strategies such as role-playing activities and guided reflection are useful in demonstrating economic factors that influence health and promote better understanding of externalities that shape the health status of individuals and communities.
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Affiliation(s)
- Aldrin B Loyola
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
| | - Lia M Palileo-Villanueva
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
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Gonzalo JD, Chang A, Dekhtyar M, Starr SR, Holmboe E, Wolpaw DR. Health Systems Science in Medical Education: Unifying the Components to Catalyze Transformation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1362-1372. [PMID: 32287080 DOI: 10.1097/acm.0000000000003400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medical education exists in the service of patients and communities and must continually calibrate its focus to ensure the achievement of these goals. To close gaps in U.S. health outcomes, medical education is steadily evolving to better prepare providers with the knowledge and skills to lead patient- and systems-level improvements. Systems-related competencies, including high-value care, quality improvement, population health, informatics, and systems thinking, are needed to achieve this but are often curricular islands in medical education, dependent on local context, and have lacked a unifying framework. The third pillar of medical education-health systems science (HSS)-complements the basic and clinical sciences and integrates the full range of systems-related competencies. Despite the movement toward HSS, there remains uncertainty and significant inconsistency in the application of HSS concepts and nomenclature within health care and medical education. In this Article, the authors (1) explore the historical context of several key systems-related competency areas; (2) describe HSS and highlight a schema crosswalk between HSS and systems-related national competency recommendations, accreditation standards, national and local curricula, educator recommendations, and textbooks; and (3) articulate 6 rationales for the use and integration of a broad HSS framework within medical education. These rationales include: (1) ensuring core competencies are not marginalized, (2) accounting for related and integrated competencies in curricular design, (3) providing the foundation for comprehensive assessments and evaluations, (4) providing a clear learning pathway for the undergraduate-graduate-workforce continuum, (5) facilitating a shift toward a national standard, and (6) catalyzing a new professional identity as systems citizens. Continued movement toward a cohesive framework will better align the clinical and educational missions by cultivating the next generation of systems-minded health care professionals.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Anna Chang
- A. Chang is professor of medicine and Gold-Headed Cane Endowed Education Chair in Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Michael Dekhtyar
- M. Dekhtyar is former research associate, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics and director of science of health care delivery education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-9259-3576
| | - Eric Holmboe
- E. Holmboe is chief research, milestones development, and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor of medicine, Yale University, New Haven, Connecticut, and adjunct professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel R Wolpaw
- D.R. Wolpaw is professor of medicine and humanities, Penn State University College of Medicine, Hershey, Pennsylvania
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DallaPiazza M, Ayyala MS, Soto-Greene ML. Empowering future physicians to advocate for health equity: A blueprint for a longitudinal thread in undergraduate medical education. MEDICAL TEACHER 2020; 42:806-812. [PMID: 32180494 DOI: 10.1080/0142159x.2020.1737322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In light of a growing body of evidence demonstrating pervasive health disparities, medical schools are increasingly incorporating educational programs on social medicine in undergraduate and graduate medical curricula. In 2015, we significantly restructured the cultural competency instruction for medical students at our institution, focusing on achieving greater health equity through caring for vulnerable populations and acknowledging and addressing bias and stereotyping. In order to facilitate educational sustainability while students were immersed in clinical care, a key element of our approach included extending teaching into the clerkship year. The resulting longitudinal thread, Health Equity and Social Justice, empowers future physicians with the knowledge and skills to work towards greater health equity. This article discusses the lessons learned in the implementation of this novel educational program. Our approach can serve as a model for other institutions considering similar instructional reform.
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Affiliation(s)
- Michelle DallaPiazza
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Manasa S Ayyala
- Department of Medicine, Division of General Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Rao R, Hawkins M, Ulrich T, Gatlin G, Mabry G, Mishra C. The Evolving Role of Public Health in Medical Education. Front Public Health 2020; 8:251. [PMID: 32714890 PMCID: PMC7344251 DOI: 10.3389/fpubh.2020.00251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 05/20/2020] [Indexed: 11/15/2022] Open
Abstract
Medical education in the twentieth century was largely influenced by the Flexner Report, with significant proportions of instruction dedicated to the molecular underpinnings of the pathologic pathways and minimal mention of the socio-ecological determinants of health. When examining the predominant diseases of the twenty first century landscape, widening health disparities, and significant changes in the United States healthcare system, it is imperative to view wellness and sickness in a broader public health context rather than a singular focus of the biomedical model. While undergraduate opportunities to study public health are on the rise in the United States, there is a parallel urgency for medical curricula to recognize the importance of the complex interrelated socio-ecological root causes of health, well-being, and illness. In order to reduce the risk of non-communicable diseases and increase health equity, it is necessary for medical education to integrate core public health knowledge and competencies. Contemporary health challenges require a public health approach, in addition to clinical skills, for physicians to provide equitable care. The COVID-19 pandemic further underscores the necessity to mitigate the effects of socio-ecological determinants of health. Seven key recommendations are presented from a training to practice timeline emphasizing the important linkages between medical education, socio-ecological influences on health, and public health. As the health challenges in society and communities shift, so too must training of future physicians. There is a need and an opportunity for medicine and public health to address the shared health challenges of our global society.
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Affiliation(s)
- Ravi Rao
- Independent Researcher, Los Angeles, CA, United States
| | - Melissa Hawkins
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Trina Ulrich
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Greta Gatlin
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Guadalupe Mabry
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Chaitanya Mishra
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
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Abstract
BACKGROUND Many global health organisations have adopted formal strategies to integrate gender in their programming. In practice, few prioritise the issue. Institutions with considerable global power therefore largely overlook fundamental drivers of adverse health outcomes: gender inequality and harmful gender norms. We analyse the factors shaping attention to gender in organisations involved in global health governance. METHODS Drawing on scholarship from the fields of organisational behavior and management, sociology, international relations and the policy process, we undertook a thematic analysis of peer-reviewed scholarship and organisational documents. We also conducted 20 semi-structured interviews over Skype with individuals working at the cross-section of gender and health. RESULTS In seeking to reform the policies and practices of global health organisations, gender proponents confront patriarchal organisational cultures, hostile political environments and an issue that is difficult to address as it requires upsetting existing power structures. Proponents also face three linked challenges internal to their own networks. First, there is little cohesion among champions themselves, as they are fragmented into multiple networks. Second, proponents differ on the nature of the problem and solutions, including whether reducing gender inequality or addressing harmful gender norms is the primary goal, the role of men in gender initiatives, which health issues to prioritise, and even the value of proponent cohesion. Third, there are disagreements among proponents on how to convey the problem. Some advance an instrumental case, while others believe that it should be portrayed as a human rights issue and using any other argument undermines that fundamental justification. CONCLUSIONS Prospects for building more gender-responsive global health organisations will depend in part on the ability of proponents to address these disagreements and develop strategies for negotiating difficult organisational cultures and political environments.
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Affiliation(s)
- Yusra Ribhi Shawar
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
| | - Jeremy Shiffman
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
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Lee J, Lee J, Jung IY. An integrated humanities-social sciences course in health sciences education: proposed design, effectiveness, and associated factors. BMC MEDICAL EDUCATION 2020; 20:117. [PMID: 32306973 PMCID: PMC7168810 DOI: 10.1186/s12909-020-02022-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous research has not provided enough direction regarding effective content design of courses integrating the humanities and social sciences in medical and dental education. This study aims at exploring how an Integrated Medical/Dental Humanities-Social Medicine/Dentistry course may be designed; how effective it may be in terms of student growth in knowledge, attitudes, skills, and aspirations; and associated factors. METHODS The course was designed by distilling commonalities in the international standards for medical/dental education proposed by seven major health organizations. This analysis resulted in a curriculum covering nine major topics: history, professionalism, communication, ethics, management, policy, insurance, law, and research methodology. During the 2017 calendar year, data was collected and statistically analyzed from 68 third-year pre-doctoral students enrolled in the resulting MDHS 13-week course. RESULTS Participants showed growth in skills, aspirations, knowledge, and attitudes, with the greatest change occurring in skills, then aspirations, knowledge, and attitudes. Knowledge growth was the only variable significantly related to student achievement of course objectives (β = 0.635, t (63) = 3.394, p = 0.001). The topics that students perceived as most critical were insurance, policy, management, and law. The perceived importance of research was most common among participants and was significantly related to all learning outcomes (For knowledge, β = 0.213, t (63) = 2.203, p = 0.031; for attitudes, β = 0.784, t (63) = 10.257, p = 0.000; for skills, β = 0.769, t (63) = 9.772, p = 0.000; and aspirations β = 0.639, t (63) = 7.595, p = 0.000). CONCLUSIONS This study proposed a framework for humanities-social sciences education in health sciences education and analyzed its implementation. The empirical evaluation of its effectiveness and factors related to successful outcomes found that students perceived gains in their knowledge, attitudes, skills, and aspirations for humanistic and social aspects of dentistry/medicine. In addition, their recognition of the importance of research was associated with the greatest growth in all four learning outcomes. This study may contribute to the improved design of integrated humanities-social sciences courses.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jueyeun Lee
- Department of Preventive Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Il Young Jung
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
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Alameddine R, Taleb R, Al-Habbal K, Patel KD. Systems thinking: advancing health advocacy training; a perspective from junior family physicians in the Middle East. EDUCATION FOR PRIMARY CARE 2020; 31:71-73. [PMID: 31959069 DOI: 10.1080/14739879.2019.1711201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Healthcare systems are becoming increasingly complex. Physicians are expected to be agents of change to meet the growing health needs. In the Middle East, young family doctors are subtly creating a space for advocacy. Recognising the need for compulsory advocacy training in undergraduate medical curricula, allows health workers and students a concrete exposure to social determinants of health by carrying out clinical encounters from the hospital setting to outpatient dispensaries in underprivileged areas. At the community level, they organise mobile clinics and engage in collaborative initiatives to provide primary healthcare services to vulnerable populations. To be successful, advocacy practice and training should move towards systems thinking. Family doctors need to engage and collaborate with other stakeholders within the healthcare system and understand the dynamics of the relationships between them. This empowers their role in national health agendas, especially those related to universal health coverage (UHC). Future physicians and all members of primary care teams need to partner with people outside their discipline; the idea of interdisciplinary and interprofessional collaboration should be integrated into their schooling and all forms of vocational training.
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Affiliation(s)
- Reina Alameddine
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rim Taleb
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Khairat Al-Habbal
- Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Kunal D Patel
- Faculty of Health, Social Care and Education, Kingston University and St Georges, University of London, UK.,Research and Advocacy, iheed, Dublin, Ireland
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Daccache J, Khoury M, Habibi C, Bennett S. More than Just Soup: Use of a Student-Led COVID-19 Social Pediatrics Initiative to Propose the Integration of Social Medicine Electives in Undergraduate Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520973210. [PMID: 33283048 PMCID: PMC7691902 DOI: 10.1177/2382120520973210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The need to educate medical students on the social forces shaping disease and health patterns is paramount in preparing incoming physicians with the aptitudes to address health inequities. Despite its well-documented merit as a model of practice, social medicine remains underrepresented at the undergraduate medical education level. We hypothesize that the success of this student-led COVID-19 initiative proposes a tangible and innovative solution to address the lack of social medicine exposure in undergraduate medical education. METHODOLOGY We sought to evaluate the impact of sustaining clinical learning during the pandemic using the social pediatrics model as a didactic vector for clerkship students. We extracted learning objectives relevant to the teaching of social medicine from the Royal College of Physicians and Surgeons of Canada's CanMEDS framework and developed a survey aimed at evaluating the attainability of each of those objectives. The survey was distributed to students enrolled in the social pediatrics COVID-19 initiative after 6 weeks (April-May), as well as a control group. RESULTS Completing the survey were 19 students from the University of Ottawa Faculty of Medicine, 7 in the intervention group and 12 in the control group. Students that participated in the social pediatrics initiative yielded significantly higher values for the achievement of 6 out of 9 social medicine learning objectives when compared to the control group. Although the values followed a similar trend for the remaining 3 objectives, favoring the intervention group, they were not statistically significant. CONCLUSION The positive results from this study and the COVID-19 student-led initiative template can serve as a catalyst for curricular change so as to ensure graduates are adequately trained to contend with the realities of the social landscape in which they will practice. Future plans include the incorporation of interactive social medicine experiences throughout all 4 years of medical school.
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Affiliation(s)
| | - Michel Khoury
- Faculty of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
| | - Charlene Habibi
- Faculty of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
| | - Susan Bennett
- Faculty of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
- Director of Social Pediatrics,
Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Dingle AD, Torres-Reveron A, Gil M, Fernandez F, Escobedo IM, Terry V, Maestre GE, de Erausquin GA. Mind, Brain, and Behavior: an Integrative Approach to Teaching Neuroscience to Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:639-643. [PMID: 31222575 PMCID: PMC8722773 DOI: 10.1007/s40596-019-01079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Arden D Dingle
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
| | | | - Mario Gil
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Francisco Fernandez
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | | | - Valerie Terry
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Gladys E Maestre
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
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Godfrey S, Nickerson K, Amiel J, Lebwohl B. Development of an online public health curriculum for medical students: the public health commute. BMC MEDICAL EDUCATION 2019; 19:298. [PMID: 31376832 PMCID: PMC6679425 DOI: 10.1186/s12909-019-1734-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/26/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND As public health becomes increasingly central to the practice of medicine, educational efforts are necessary to prepare medical students to apply public health concepts in their care of patients. There are few accessible and informative tools to prepare students to engage with population health challenges. METHODS We distributed an online questionnaire to clinical students, querying gaps in their education on public health topics. Based upon the responses, we developed a web-based curriculum for medical students rotating at a public safety-net hospital on pediatrics, medicine, primary care, psychiatry, and surgery services from April-December 2017 (available at www.publichealthcommute.com ). Students received guiding questions and media-based resources (e.g. podcasts, TedTalks, YouTube videos) in weekly modules addressing topics in public health. Each module incorporated 30 min of mobile-optimized content, including specific data relating the topic to the Central Harlem community. Familiarity with public health was assessed with pre- and post-program quizzes, including 10 multiple-choice and 2 open-ended questions. RESULTS Among the 70 participating students, 59 (84%) completed both the pre- and post-assessments. The five-week curriculum covered health systems, social determinants, race, substance use, violence, and alternative care models. After completing the five-week curriculum, the mean correct score on a multiple-choice quiz rose from 57 to 66% (p = 0.001). In the qualitative section of the test, students were asked what public health topics should be taught in medical school. Frequently suggested topics included social determinants of health (25%), epidemiology (25%), health systems (25%), insurance (21%), policy (17%), economics (17%), racism (15%), and health disparities (8%). When asked how public health will impact their medical career, students frequently responded that it would greatly impact their clinical practice (49%), choice of residency program (17%), and decision to pursue advocacy or additional degrees (15%). CONCLUSIONS Learners participating in this five-week online public health curriculum demonstrated a significant increase in public health knowledge. The online format allowed for high participation across five different specialty rotations, and community-specific data allowed students to recognize the importance of public health in medical practice.
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Affiliation(s)
- Sarah Godfrey
- Columbia Vagelos College of Physicians and Surgeons, 630 W 168th St., New York, NY 20032 USA
| | - Katherine Nickerson
- Columbia Vagelos College of Physicians and Surgeons, 630 W 168th St., New York, NY 20032 USA
| | - Jonathan Amiel
- Columbia Vagelos College of Physicians and Surgeons, 630 W 168th St., New York, NY 20032 USA
| | - Benjamin Lebwohl
- Columbia Vagelos College of Physicians and Surgeons, 630 W 168th St., New York, NY 20032 USA
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Taira BR, Hsieh D. Advancing the Biosocial Perspective in the Clinical Training Environment: Surmounting the Barriers and Constructing the Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1094-1098. [PMID: 30801271 DOI: 10.1097/acm.0000000000002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Calls for integrating the biosocial perspective into medical education are abundant. The core curricula of most of health professions education, however, have yet to fully integrate this concept. In this Invited Commentary, the authors describe barriers to implementation-the lack of a shared vocabulary, core curriculum, and clinical metrics-and propose a framework for implementing curricula in social medicine and structural competence. Advancing the biosocial perspective necessitates concerted efforts to link classroom training in social medicine to the clinical training environment by implementing tools to identify and address structural vulnerability in the clinical setting. Creating clinical metrics that value health outcomes instead of processes will enable educators to model clinical practice that integrates the social determinants of health as a core component. Finally, formalizing and emphasizing social medicine in graduate medical education will reinforce and solidify the importance of the biosocial perspective in the future clinical practice of our trainees.
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Affiliation(s)
- Breena R Taira
- B.R. Taira is health sciences assistant professor of emergency medicine, Olive View-UCLA Medical Center and the UCLA David Geffen School of Medicine, Los Angeles, California, and director, Section of International and Domestic Health Equity and Leadership (IDHEAL), UCLA Department of Emergency Medicine, Sylmar, California; ORCID: https://orcid.org/0000-0002-2510-651X. D. Hsieh is health sciences assistant professor of emergency medicine, Harbor-UCLA Medical Center and UCLA David Geffen School of Medicine, Los Angeles, California, and director, Medical Legal Community Partnerships for Whole Person Care, Los Angeles County Department of Health Services, Torrance, California; ORCID: http://orcid.org/0000-0003-1531-8321
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Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J Gen Intern Med 2019; 34:720-730. [PMID: 30993619 PMCID: PMC6502919 DOI: 10.1007/s11606-019-04876-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. OBJECTIVE This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). METHODS In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. RESULTS The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). CONCLUSIONS The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.
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Affiliation(s)
- Ashti Doobay-Persaud
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Mark D Adler
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tami R Bartell
- Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Natalie E Sheneman
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mayra D Martinez
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen A Mangold
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia Smith
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bromage B, Encandela JA, Cranford M, Diaz E, Williamson B, Spell VT, Rohrbaugh RM. Understanding Health Disparities Through the Eyes of Community Members: a Structural Competency Education Intervention. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:244-247. [PMID: 29761285 DOI: 10.1007/s40596-018-0937-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Young K, Fisher J, Kirkman M. Partners instead of patients: Women negotiating power and knowledge within medical encounters for endometriosis. FEMINISM & PSYCHOLOGY 2019. [DOI: 10.1177/0959353519826170] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Endometriosis is currently poorly understood by the medical sciences; contemporary healthcare has been evidenced as failing to meet the diverse needs of the women who live with the condition. This study examined women’s experiences of navigating knowledge and power within medical encounters for endometriosis. In-depth interviews were conducted with 26 women who have been diagnosed with endometriosis about their experiences of the condition and associated healthcare. Women valued both their own knowledge and their doctor’s clinical expertise; as to which they privileged was situational, but it was essential the woman dictated which it would be. Women were wary of the social status and power of doctors to reduce their wellbeing through medical labels they did not identify with or by inhibiting their access to care. They identified the need for doctors to listen to and believe them as being essential to the provision of healthcare that meets women’s needs and addresses the complexities of endometriosis. Our findings suggest that medical education needs to equip doctors with the skills to acknowledge and incorporate women’s knowledge of their bodies within the medical encounter, and to understand how their practice affects women’s social and economic participation.
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Edelsack PS, Khan T, Geiger J. Teaching Population Health and Community Health Assessment to Undergraduate Medical Students. STRUCTURAL COMPETENCY IN MENTAL HEALTH AND MEDICINE 2019:87-97. [DOI: 10.1007/978-3-030-10525-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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DallaPiazza M, Padilla-Register M, Dwarakanath M, Obamedo E, Hill J, Soto-Greene ML. Exploring Racism and Health: An Intensive Interactive Session for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10783. [PMID: 30800983 PMCID: PMC6354798 DOI: 10.15766/mep_2374-8265.10783] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/10/2018] [Indexed: 05/14/2023]
Abstract
Introduction Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Methods Over the academic years of 2016-2017, 2017-2018, and 2018-2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10-12 students with one upper-level student facilitator. Results The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Discussion Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.
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Affiliation(s)
- Michelle DallaPiazza
- Assistant Professor, Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School
| | | | - Megana Dwarakanath
- Resident,, Department of Pediatrics, University of New Mexico School of Medicine
| | | | - James Hill
- Associate Dean of Students, Department of Psychiatry, Rutgers New Jersey Medical School
| | - Maria L. Soto-Greene
- Professor of Medicine, Rutgers New Jersey Medical School; Vice Dean, Rutgers New Jersey Medical School; Director, Hispanic Center of Excellence, Rutgers New Jersey Medical School
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