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Dube AR, Ortega P, Hardin DM, Hardin K, Martinez F, Shah M, Naimi BR, Esteban-González AI, Dickmeyer J, Ruggiero D, Abraham V, Diamond LC, Cowden JD. Improving Assessment and Learning Environments for Graduate Medical Trainees to Advance Healthcare Language Equity. J Gen Intern Med 2024; 39:696-705. [PMID: 38093027 DOI: 10.1007/s11606-023-08527-3] [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] [Received: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 03/28/2024]
Abstract
Language-appropriate care is critical for equitable, high-quality health care, but educational standards to assure graduate medical trainees are prepared to give such care are lacking. Detailed guidance for graduate medical education is provided by the Accreditation Council for Graduate Medical Education through the following: (1) an assessment framework for competencies, subcompetencies, and milestones for trainees and (2) the Clinical Learning Environment Review (CLER) Pathways for assessment of trainees' learning environments. These tools do not include a robust framework to evaluate trainees' abilities to offer language-appropriate care. They also do not address the learning environment's potential to support such care. A multidisciplinary group of linguistic, medical, and educational experts drafted a new subcompetency with milestones and an expanded CLER Pathway to highlight the importance of equitable care for patients who prefer languages other than English. These resources offer residency and fellowship programs tools to guide assessment, curriculum development, and learning-environment improvements related to language-appropriate care. Recognizing that programs have unique needs and resources, we propose a range of initial actions to address language equity. A focus on language diversity in the learning environment can have a broad and lasting impact on care quality, patient safety, and health equity.
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Affiliation(s)
- Amanda R Dube
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Pilar Ortega
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | | | - Francisco Martinez
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Madhura Shah
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - Jodi Dickmeyer
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Veronica Abraham
- F Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lisa C Diamond
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Stall M, Germann JN, Orta M, Winick N, Kaye EC. Equitable communication for pediatric cancer patients and families who speak languages other than English. Pediatr Blood Cancer 2024; 71:e30828. [PMID: 38146021 PMCID: PMC10831864 DOI: 10.1002/pbc.30828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Melanie Stall
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Julie N. Germann
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
- Children’s Medical Center Dallas, Department of Psychiatry, Dallas, TX, USA
| | - Martin Orta
- Children’s Medical Center Dallas, Department of Language Access Services, Dallas, TX, USA
| | - Naomi Winick
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Department of Oncology, Memphis, TN, USA
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Fukui N, Partain DK, Yeow ME, Farfour HN, Prokop L, Barwise A. Learning to collaborate with medical interpreters in health professions education: A systematic review of training programs. MEDICAL TEACHER 2024; 46:258-272. [PMID: 37625438 DOI: 10.1080/0142159x.2023.2249211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Working effectively with medical interpreters is an increasingly valuable skill for clinicians to provide high-quality medical care. We aimed to assess the effectiveness of existing training programs that teach optimal collaboration practices between clinicians and interpreters during patient encounters. METHODS We searched MEDLINE, EMBASE, Scopus, and Cochrane Central for studies published from 1945 through June 21, 2022. RESULTS Out of the 1689 studies screened, we identified 19 studies that met inclusion criteria. Participants were from diverse professions, medical specialities, and training levels. Interpreter involvement in the development or delivery of the program was mentioned in 63% of the evaluated studies. There was substantial variability in training design, assessment methods, and reported outcomes. Only 10 of the programs included an objective knowledge or skills assessment. Only one study conducted a longitudinal assessment of skill maintenance over time. The training programs were generally well received. CONCLUSIONS There is a critical need for structured programs to train clinicians to effectively collaborate with medical interpreters to reduce healthcare disparities. An effective training program should involve interpreters in the development and delivery of the program, practical skills development through interactive activities, structured clinical skill assessment, and both in-person and virtual components.
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Affiliation(s)
- Natsu Fukui
- Division of Palliative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Daniel K Partain
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Mei-Ean Yeow
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | | | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Nadir N, Winfield A, Bentley S, Hock SM, Backster A, Bradby C, Rotoli J, Jones N, Falk M. Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study. AEM EDUCATION AND TRAINING 2023; 7:S78-S87. [PMID: 37383838 PMCID: PMC10294220 DOI: 10.1002/aet2.10870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 06/30/2023]
Abstract
Background The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. Method This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Results Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. Conclusions There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.
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Affiliation(s)
- Nur‐Ain Nadir
- Department of Emergency MedicineKaiser Permanente Central ValleyModestoCaliforniaUSA
- Department of Clinical ScienceKaiser Permanente Bernard Tyson School of MedicinePasadenaCaliforniaUSA
| | | | - Suzanne Bentley
- Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Emergency MedicineElmhurst Hospital CenterElmhurstNew YorkUSA
| | - Sara M. Hock
- Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - Cassandra Bradby
- Emergency MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jason Rotoli
- Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nathaniel Jones
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael Falk
- Pediatric Emergency MedicineChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
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Chung AS, Cardell A, Desai S, Porter E, Ghei R, Akinlosotu J, Ogedegbe C. Educational Outcomes of Diversity Curricula in Graduate Medical Education. J Grad Med Educ 2023; 15:152-170. [PMID: 37139216 PMCID: PMC10150806 DOI: 10.4300/jgme-d-22-00497.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/01/2022] [Accepted: 02/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background Education is an important step toward achieving equity in health care. However, there is little published literature examining the educational outcomes of curricula for resident physicians focused on diversity, equity, and inclusion (DEI). Objective Our objective was to review the literature to assess the outcomes of curricula for resident physicians of all specialties focused on DEI in medical education and health care. Methods We applied a structured approach to conducting a scoping review of the medical education literature. Studies were included for final analysis if they described a specific curricular intervention and educational outcomes. Outcomes were characterized using the Kirkpatrick Model. Results Nineteen studies were included for final analysis. Publication dates ranged from 2000 to 2021. Internal medicine residents were the most studied. The number of learners ranged from 10 to 181. The majority of studies were from a single program. Educational methods ranged from online modules to single workshops to multiyear longitudinal curricula. Eight studies reported Level 1 outcomes, 7 studies reported Level 2 outcomes, 3 studies reported Level 3 outcomes, and only 1 study measured changes in patient perceptions due to the curricular intervention. Conclusions We found a small number of studies of curricular interventions for resident physicians that directly address DEI in medical education and health care. These interventions employed a wide array of educational methods, demonstrated feasibility, and were positively received by learners.
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Affiliation(s)
- Arlene S. Chung
- Arlene S. Chung, MD, MACM, FACEP, is Associate Professor of Clinical Emergency Medicine, Vice Chair of Education, and Residency Director, Department of Emergency Medicine, Maimonides Medical Center
| | - Annemarie Cardell
- Annemarie Cardell, MD, is Clinical Assistant Professor of Emergency Medicine and Associate Director of Clinical Informatics, Department of Emergency Medicine, Maimonides Medical Center
| | - Smruti Desai
- Smruti Desai, DO, MPH, MA, is Simulation Faculty, Department of Emergency Medicine, Maimonides Medical Center
| | - Evelyn Porter
- Evelyn Porter, MD, MS, is Assistant Program Director, Department of Emergency Medicine, University of San Francisco
| | - Ridhima Ghei
- Ridhima Ghei, MD, is a PGY-3 Resident, Department of Emergency Medicine, Maimonides Medical Center
| | - Joanna Akinlosotu
- Joanna Akinlosotu, MD, is a PGY-3 Resident, Department of Emergency Medicine, Hackensack University Medical Center
| | - Chinwe Ogedegbe
- Chinwe Ogedegbe, MD, MPH, is Professor of Emergency Medicine and Section Chief for Research, Department of Emergency Medicine, Hackensack University Medical Center and Hackensack Meridian School of Medicine
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Tam I, Huang M, Patel A, Rhee KE. Optimizing Care for Spanish-Speaking Patients and Families in the Hospital: Defining the Gaps and Interventions. Acad Pediatr 2023; 23:261-262. [PMID: 36283623 DOI: 10.1016/j.acap.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ivy Tam
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif; Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine (I Tam), Bronx, NY.
| | - Maria Huang
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
| | - Aarti Patel
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
| | - Kyung E Rhee
- Department of Pediatrics, Rady Children's Hospital San Diego and University of California San Diego (I Tam, M Huang, A Patel, and KE Rhee), San Diego, Calif
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Upton J, Kassel L, Hansen A, Butler J. Examining Social Identities of Patient Diversity Through Cases Presented in a Therapeutics Course Series. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8706. [PMID: 34862176 PMCID: PMC10159468 DOI: 10.5688/ajpe8706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/29/2021] [Indexed: 05/06/2023]
Abstract
Objective. In pharmacy education, considerable debate surrounds the decision about whether didactic cases should include social identities, such as race, ethnicity, sexual orientation, gender identity, ability, spirituality, nationality, and socioeconomic status. In considering what and how much of these identities to include, the first step could be to measure their current inclusion. This study aimed to quantify the presence of these social identities in cases presented to student pharmacists in a three-semester course series.Methods. One hundred forty-four cases presented in a three-semester pharmacotherapeutics course series were reviewed. The primary objective was to quantify the inclusion of each social identity. The secondary objective was to assess whether the identities were needed to answer specific questions related to each case. Cases were reviewed by two independent study researchers; a third impartial reviewer settled disagreements.Results. Cases rarely explicitly included social identities. Race was explicitly stated in 15% of cases (n = 21). Gender identity was explicitly named in two cases (1%), but nearly all cases implied gender through pronouns. Gender was necessary to answer case questions in approximately 20% of cases (n=27). Socioeconomic status, ability, sexual orientation, and nationality were infrequently named among all cases, at rates of 6%, 5%, 1%, and 1%, respectively.Conclusion. This study found that didactic cases rarely explicitly state social identities. In determining the next steps for integrating social identities, pharmacy education must first take stock of how it currently acknowledges these identities.
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Affiliation(s)
- Jesse Upton
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Lynn Kassel
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Anisa Hansen
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Jared Butler
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
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