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Dawson AE, Ray Bignall ON, Spencer JD, McLeod DJ. A Call to Comprehensively Understand Our Patients to Provide Equitable Pediatric Urological Care. Urology 2023; 179:126-135. [PMID: 37393019 DOI: 10.1016/j.urology.2023.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Anne E Dawson
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio; The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio
| | - O N Ray Bignall
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - John David Spencer
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Daryl J McLeod
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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Rosencranz H, Ramkumar J, Herzog L, Lavey W. Policy Advocacy Workshop Tools for Training Medical Students to Act on Climate Change. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11337. [PMID: 37601458 PMCID: PMC10432578 DOI: 10.15766/mep_2374-8265.11337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/19/2023] [Indexed: 08/22/2023]
Abstract
Introduction Doctors are trusted voices for communities and can influence lawmakers on climate change. Effective climate policy advocacy requires awareness, knowledge, and skills not typically taught in medical schools. Such curriculum additions could help students describe reasons for physicians to engage in climate policy advocacy and compose advocacy presentations. Methods To empower engagement in climate policies and develop advocacy skills, we deployed three 90-minute workshops at three institutions for first-, second-, and fourth-year students. The workshops included background on various climate policies of concern to health care professionals, advocacy guidance, scripts and factsheets from physicians' meetings illustrating advocacy opportunities for students and physicians, and active learning exercises. The exercises utilized advocacy templates and actual proposed actions on climate change. Students worked in small groups on advocacy presentations' content and format. Each group shared its work, and facilitators provided feedback. Results Out of 102 participants, 29 completed a survey (28% response rate). Using a Likert scale and narratives, students reported significant improvements in readiness to advocate for legislation or policies to mitigate the health effects of climate change, awareness of advocacy opportunities, and capability to prepare advocacy documents. Discussion Workshops on climate policy advocacy can equip medical students with important perspectives on their responsibilities and opportunities, as well as skills to be effective. The physician's voice is critical to promoting policies related to the health impacts of climate change. Targeted workshops with actual examples and exercises on climate advocacy are feasible and important additions to the curriculum.
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Affiliation(s)
- Holly Rosencranz
- Clinical Associate Professor, Department of Medicine, University of Illinois College of Medicine at Urbana and Carle Illinois College of Medicine
| | - Japhia Ramkumar
- Clinical Associate Professor, Department of Medicine, University of Illinois College of Medicine at Urbana and Carle Illinois College of Medicine
| | | | - Warren Lavey
- Adjunct Professor, School of Earth, Society & Environment and College of Law, University of Illinois at Urbana-Champaign and Carle Illinois College of Medicine
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Shah S. Going Farther by Going Together: Collaboration as a Tool in Advocacy. Pediatr Clin North Am 2023; 70:181-191. [PMID: 36402467 DOI: 10.1016/j.pcl.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With greater understanding of the impact of social determinants on child health, advocacy has become essential to promoting children's health, particularly at the population level. Successful advocacy requires coalition building. Steps on how to create a productive coalition, including the selection of partner organizations, understanding how these groups enhance your activities, and strict definition of assigned roles is reviewed. Examples of successful coalitions are reviewed. A list of potential partners, who focus on various aspects of child health, is provided.
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Affiliation(s)
- Shetal Shah
- Division of Newborn Medicine C-225A, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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Reshaping Social Determinants-Charting a Path Forward for Providers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:445-447. [PMID: 35867499 DOI: 10.1097/phh.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Emery EH, Shaffer JD, McCormick D, Zeidman J, Geffen SR, Stojicic P, Ganz M, Basu G. Preparing Doctors in Training for Health Activist Roles: A Cross-Institutional Community Organizing Workshop for Incoming Medical Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11208. [PMID: 35106380 PMCID: PMC8763867 DOI: 10.15766/mep_2374-8265.11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Physicians are increasingly being called on to address inequities created by social and structural determinants of health, yet few receive training in specific leadership skills that allow them to do so effectively. METHODS We developed a workshop to introduce incoming medical interns from all specialties at Boston-area residency programs to community organizing as a framework for effective physician advocacy. We utilized didactic sessions, video examples, and small-group practice led by trained coaches to familiarize participants with one community organizing leadership skill-public narrative-as a means of creating the relationships that underlie collective action. We offered this 3-hour, cross-institutional workshop just prior to intern orientation and evaluated it through a postworkshop survey. RESULTS In June 2019, 51 residents from 13 programs at seven academic medical centers attended this workshop. In the postworkshop survey, participants agreed with positive evaluative statements about the workshop's value and impact on their knowledge, with a mean score on all items of over 4 (5-point Likert scale, 1 = strongly disagree, 5 = strongly agree; response rate: 34 of 51). Free-text comments emphasized the workshop's effectiveness in evoking positive feelings of solidarity, community, and professional identity. DISCUSSION The workshop effectively introduced participants to community organizing and public narrative, allowed them to apply the principles of public narrative by developing their own stories of self, and demonstrated how these practices can be utilized in physician advocacy. The workshop also connected participants to their motivations for pursuing medicine and stimulated interest in more community organizing training.
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Affiliation(s)
- Eleanor H. Emery
- Program Officer, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Instructor of Medicine, Part-time, Harvard Medical School; Medical Officer-Physician, Department of Internal Medicine, Northern Navajo Medical Center
| | | | - Danny McCormick
- Co-Director, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Associate Professor of Medicine, Harvard Medical School
| | - Jessica Zeidman
- Primary Care Program Director, Department of Internal Medicine, Massachusetts General Hospital; Instructor of Medicine, Harvard Medical School
| | - Sophia R. Geffen
- Program Manager, Center for Health Equity Education and Advocacy, Cambridge Health Alliance
| | - Predrag Stojicic
- Instructor, Harvard T.H. Chan School of Public Health; Program Director for Community Organizing, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Executive Director, People Power Health
| | - Marshall Ganz
- Rita E. Hauser Senior Lecturer in Leadership, Organizing, and Civil Society, Harvard Kennedy School
| | - Gaurab Basu
- Co-Director, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Instructor of Medicine, Harvard Medical School
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Morrison JM, Marsicek SM, Hopkins AM, Dudas RA, Collins KR. Using simulation to increase resident comfort discussing social determinants of health. BMC MEDICAL EDUCATION 2021; 21:601. [PMID: 34872529 PMCID: PMC8647375 DOI: 10.1186/s12909-021-03044-5] [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] [Received: 01/08/2021] [Accepted: 11/17/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills. METHODS We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9-12 months after participation. RESULTS 85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38-47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02). DISCUSSION Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.
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Affiliation(s)
- John M Morrison
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Sarah M. Marsicek
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, AdventHealth for Children, FL Orlando, USA
| | - Akshata M Hopkins
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
| | - Kimberly R Collins
- Department of Pediatrics, Johns Hopkins University School of Medicine, MD Baltimore, USA
- Division of Pediatric Hospital Medicine, Department of Pediatric Medicine, Johns Hopkins All Children’s Hospital, FL St Petersburg, USA
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Traba C, Jain A, Pianucci K, Rosen-Valverde J, Chen S. Down to the Last Dollar: Utilizing a Virtual Budgeting Exercise to Recognize Implicit Bias. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11199. [PMID: 34917754 PMCID: PMC8645532 DOI: 10.15766/mep_2374-8265.11199] [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: 01/11/2021] [Accepted: 08/31/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION As social determinants of health and implicit bias are recognized as critical components of medical education, there is a need for novel approaches beyond didactics. We developed a small-group budgeting exercise to simulate the impact of poverty. Pediatrics exemplifies the effects of poverty on the family. This exercise allowed students to recognize the effects of food insecurities on health and reflect on biases regarding patients living in poverty. METHODS The virtual interactive budgeting exercise (1.5-2 hours) introduced third-year pediatric clerkship students to the challenges faced by a single parent living in poverty, requiring them to make choices on which budget items were most important. Students attempted to balance budgets within small breakout groups, followed by a group reflection on biases encountered. A faculty facilitator then debriefed with the larger group. RESULTS Within the first four rotations of the 2020-2021 academic year, 75 students completed the budgeting exercise and reflection, with 61 students completing the postexercise survey evaluation. Between 94% and 98% rated the objectives as met to a moderate, considerable, or very high degree. In addition, 98% of students noted the group discussion heightened their awareness regarding biases, and 95% agreed or strongly agreed the activity was conducted virtually without difficulty. DISCUSSION This simulated budgeting exercise provides a well-rounded experience for medical students, that can be administered at either the preclerkship or clerkship level, at a minimal cost, with interactive engagement of students in a virtual environment and reflection on biases within a group context.
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Affiliation(s)
- Christin Traba
- Assistant Professor, Department of Pediatrics, Rutgers New Jersey Medical School
| | - Aditi Jain
- Second-Year Pediatric Resident, University of Pittsburgh Medical Center
| | | | | | - Sophia Chen
- Assistant Professor, Department of Pediatrics, Rutgers New Jersey Medical School
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Goldman RH, Zajac L, Geller RJ, Miller MD. Developing and implementing core competencies in children's environmental health for students, trainees and healthcare providers: a narrative review. BMC MEDICAL EDUCATION 2021; 21:503. [PMID: 34560874 PMCID: PMC8464086 DOI: 10.1186/s12909-021-02921-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/01/2021] [Indexed: 05/29/2023]
Abstract
Knowledge of the health impacts of environmental exposures (such as pollution disasters, poor air quality, water contamination, climate change) on children's health has dramatically increased in the past 40 years. The World Health Organization (WHO) estimated that 23% of all deaths worldwide were attributable to the environment, and 26% of deaths in children less than 5 years old could be prevented with removal of environmental risks factors. Yet, little has permeated medical education, leaving pediatric providers ill equipped to address these issues. To address this gap, members from the Pediatric Environmental Health Specialty Units, a United States nationwide network of academically affiliated experts who have created numerous environmental health educational materials and programs, have identified fifteen core environmental health (EH) competencies needed by health care providers to enable them to effectively address environmental health concerns. These competencies can serve as the foundation for the development and implementation of relevant educational programs. The core EH competencies are based upon these foundational elements: 1) Definition of "children's environmental health" that describes how environmental exposures (positive and negative) in early life influence the health and development in childhood and across the entire human life span 2) Children are not "little adults" and so have unique vulnerabilities to environmental hazards; 3) Environmental health inequities exist, causing some children to have a disproportionate amount of unhealthy exposures and consequently a greater risk of adverse effects; 4) Climate change will translate to numerous adverse health effects that will particularly affect children worldwide. In this article, the authors describe the core environmental health competencies and provide resources, online tools, strategies, and examples targeted to all levels of training and practice to better enable leaders and educators to bring this important content to the forefront.
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Affiliation(s)
- Rose Hannah Goldman
- Department of Medicine, Cambridge Health Alliance, Cambridge Massachusetts, Cambridge Hospital, Macht Center 427, Cambridge, MA, 02139, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Lauren Zajac
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Robert J Geller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mark D Miller
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, California, San Francisco, USA
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