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Nour N, Onchonga D, Neville S, O'Donnell P, Abdalla ME. Integrating the social determinants of health into graduate medical education training: a scoping review. BMC MEDICAL EDUCATION 2024; 24:565. [PMID: 38783280 PMCID: PMC11119707 DOI: 10.1186/s12909-024-05394-2] [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: 06/27/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs. METHODS A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded. RESULTS The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum. CONCLUSION Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.
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Affiliation(s)
- Nehal Nour
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - David Onchonga
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Siobhan Neville
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - Patrick O'Donnell
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Mohamed Elhassan Abdalla
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
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Oppenlander KE, Raleigh MF. Implementation of Formal Curriculum on Health Care Disparities in Military Family Medicine Residency. Fam Med 2024; 56:190-194. [PMID: 38467036 PMCID: PMC11136623 DOI: 10.22454/fammed.2024.683797] [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: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) requires education on health care disparities (HCD), but research assessing formal curricula is limited. To improve knowledge and confidence in HCD, the family medicine residency program at Darnall Army Medical Center implemented a formal HCD curriculum. METHODS During the 2021-2022 academic year, starting July 2021, a formal HCD curriculum was implemented for family medicine residents and faculty. Ten lectures on HCDs and implicit bias were given over the course of the year. Residents and faculty were asked to incorporate HCD into their regular continuing medical education lectures. ACGME survey data as well as a pre- and postcurriculum survey were used to assess HCD knowledge and confidence. Descriptive statistics and a paired-sample t tests were calculated to compare pre- to postcurriculum changes. RESULTS The percentage of residents who reported that they had received HCD education increased from 72% on the 2021 ACGME survey to 100% in 2022 (N=18). We found a significant (P<.05) improvement in knowledge and confidence across 11 of 12 questions on the pre- and postcurriculum survey. CONCLUSIONS A formal curriculum in a military family medicine residency setting was effective for improving self-reported HCD knowledge and confidence.
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Affiliation(s)
| | - Meghan F. Raleigh
- Family Medicine Residency Program, Carl R Darnall Army Medical CenterFort Cavazos, TX
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Breatnach CR, Floh A, Hamilton M, Mema B. Cased-based education rounds-the eternal heart of an international training program. Front Pediatr 2024; 12:1306020. [PMID: 38464897 PMCID: PMC10920320 DOI: 10.3389/fped.2024.1306020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 03/12/2024] Open
Abstract
Case-based teaching or "Morning Rounds" have been used in medical education for more than a century and remain a cornerstone for teaching in many training programs. Our Pediatric Critical Care Medicine (PCCM) program was established forty years ago and has retained this form of teaching since its inception. Case-based rounds have consistently had the highest evaluation of all curricula in our program. Here we review the history of how these rounds were introduced in medical education, provide data from the learners' evaluation of these case-based rounds, and discuss the strengths and potential drawbacks of this form of teaching from an educational theories perspective with the hope that they can be used by other Pediatric Critical Care training programs.
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Affiliation(s)
- Colm R. Breatnach
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alejandro Floh
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melanie Hamilton
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Briseida Mema
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wykowski JH, Kelly ME, Tong HH, Osobamiro OO, Albert TJ. An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences. J Gen Intern Med 2024; 39:481-486. [PMID: 37989816 PMCID: PMC10897115 DOI: 10.1007/s11606-023-08399-7] [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: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 11/23/2023]
Abstract
Inpatient educational conferences are a key part of internal medicine residency training. Many residencies made conferences virtual during the COVID-19 pandemic, and are now returning to in-person sessions. As we navigate this change, we can seize this opportunity to re-evaluate the role that inpatient conferences serve in resident education. In this paper, we briefly review the history of inpatient educational conferences before offering five recommendations for improvement. Our recommendations include grounding conference formats in educational theory, leveraging the expertise of all potential educators, broadening content to include health equity and justice throughout all curricula, and explicitly focusing on cultivating community among participants. Recognizing that each residency program is different, we anticipate that these recommendations may be implemented differently based on program size, available resources, and current institutional practices. We also include examples of prior successful curricular reforms aligned with our principles. We hope these recommendations ensure inpatient conferences continue to be a central part of residency education for future generations of internal medicine residents.
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Affiliation(s)
- James H Wykowski
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Molly E Kelly
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hao H Tong
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Tyler J Albert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
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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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Ramadurai D, Salazar EG, Reddy A. The Need to Address Social Determinants of Health during Critical Care Training. ATS Sch 2022; 3:518-521. [PMID: 36726711 PMCID: PMC9885987 DOI: 10.34197/ats-scholar.2022-0057vl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth G. Salazar
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Neonatology and
| | - Anireddy Reddy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Okoro ON, DeVuyst-Miller SA, MacDonald DA, Montag-Schafer KG, Pereira CR, Schweiss SK, Yapel AM. Integrating social determinants into pharmacotherapy courses: A case-based learning approach. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1438-1447. [PMID: 36154989 DOI: 10.1016/j.cptl.2022.09.023] [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: 05/19/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The recognition of social determinants as major drivers of health outcomes has important implications for health care providers, including pharmacists. It is therefore imperative that providers have the requisite knowledge, skills, and attitudes to adequately address the contributions of social determinants of health (SDOH) alongside the impact of medical care on health and treatment outcomes. Case-based learning is a common practice in pharmacy education. Patient cases used in pharmacotherapy courses typically highlight clinical parameters and quantitative indices, often to the exclusion of sociocultural contexts. In actual practice, pharmacists (and other health care providers) must consider both clinical information and the context of SDOH in order to deliver responsive and effective patient care. EDUCATIONAL ACTIVITY AND SETTING The aim of the project was to build patient cases that reflect both aspects. The intent is to use these cases in the core pharmacy curriculum to teach students how to concurrently consider both clinical and social elements in patient care. Eleven pharmacists and educators participated in three work groups to develop 10 cases for pharmacotherapy courses in cardiovascular disease, diabetes management, and mental health. Two of the cases were facilitated with fourth year students on advanced pharmacy practice experiences. SUMMARY Feedback from case developers and students highlights features of the cases that lend them to utility in the pharmacy curriculum. The integration of SDOH in patient cases provides opportunity for students to build the relevant competencies that will enable them to provide holistic patient care.
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Affiliation(s)
- Olihe N Okoro
- University of Minnesota, College of Pharmacy, 235 Life Science, 1110 Kirby, Drive, Duluth, MN 55812-3003, United States.
| | | | - Danielle A MacDonald
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
| | | | - Chrystian R Pereira
- University of Minnesota, College of Pharmacy, Minneapolis, MN, United States
| | - Sarah K Schweiss
- University of Minnesota, College of Pharmacy, Duluth, MN, United States
| | - Ann M Yapel
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
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