1
|
Kerrigan V, McGrath SY, Doig C, Herdman RM, Daly S, Puruntatameri P, Lee B, Hefler M, Ralph AP. Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare. BMC Health Serv Res 2024; 24:119. [PMID: 38254093 PMCID: PMC10804863 DOI: 10.1186/s12913-024-10565-4] [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: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
Collapse
Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Cassandra Doig
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Rarrtjiwuy Melanie Herdman
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Shannon Daly
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Pirrawayingi Puruntatameri
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Royal Darwin Hospital, Darwin, NT, 0811, Australia
| |
Collapse
|
2
|
Gleeson SE, Zapata H, Bathgate ME, Emu B, Frederick J, Friedland G, Golden MP, Meyer JP, Radin J, Sideleau R, Shaw A, Shenoi SV, Trubin PA, Virata M, Barakat LA, Desruisseaux MS. Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections. Clin Infect Dis 2023; 77:703-710. [PMID: 37078888 DOI: 10.1093/cid/ciad236] [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] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.
Collapse
Affiliation(s)
- Shana E Gleeson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Heidi Zapata
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meghan E Bathgate
- The Poorvu Center for Teaching and Learning, Yale University, New Haven, Connecticut, USA
| | - Brinda Emu
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Frederick
- The Poorvu Center for Teaching and Learning, Yale University, New Haven, Connecticut, USA
| | - Gerald Friedland
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Marjorie P Golden
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jaimie P Meyer
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joanna Radin
- Department of History, Yale University, New Haven, Connecticut, USA
| | - Robert Sideleau
- New England AIDS Education and Training Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Albert Shaw
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sheela V Shenoi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul A Trubin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Virata
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lydia A Barakat
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | |
Collapse
|
3
|
Gu J, Ross J, Leitch S. Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise. J Prim Health Care 2023; 15:281-287. [PMID: 37756233 DOI: 10.1071/hc23070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Healthcare inequity disproportionately affects minority populations in Aotearoa New Zealand. Healthcare providers may contribute to inequity due to their biases. Medical education can unintentionally promote biases by reinforcing stereotypes or limiting exposure to diversity. Teaching staff from the Department of General Practice and Rural Health suggested a need to review current teaching materials to ascertain if they have the potential to contribute to this bias. Aim The aim of this study was to review case-based teaching material to determine its representation of the New Zealand population, and whether there is potential to contribute to implicit bias. Methods Document analysis of 135 cases used to teach fourth- and fifth-year medical students in the Department of General Practice and Rural Health, Otago Medical School was performed. Demographic, clinical and social features of each case were recorded and analysed. Results Cases typically included patient age (129/135, 95.6%), sex (127/135, 94.1%) and occupation status (91/136, 66.9%). Ethnicity (31/135, 23.0%), living situation (55/135, 40.7%), relationship status (57/135, 42.2%) and sexual orientation (52/135, 40.0%) were less frequently defined. Cases typically represented the population majority norms. Discussion Case-based teaching materials require regular review and updating to match population demographics. There is potential to improve representation of diversity, and hence cultural safety, though review and revision of written teaching cases.
Collapse
Affiliation(s)
- Jessica Gu
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jim Ross
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sharon Leitch
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
4
|
Gborkorquellie TT, Ward MC, Falusi OO, Barber AN, Smith TK. Diversity, Equity, Inclusion, and Justice in Medical Education: A Faculty Development Perspective. Pediatr Ann 2023; 52:e266-e272. [PMID: 37427969 DOI: 10.3928/19382359-20230516-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
As many residency programs expand teaching to address the knowledge, skills, and attitudes that residents need to dismantle structural racism and other systemic inequities, many faculty are not prepared to teach these topics. However, there is limited literature on which to base faculty development in this area. The aim of this article is to review how diversity, equity, inclusion, and justice education is integrated in pediatric faculty development efforts. This review will include published and gray literature on curricula and programs in medical education for faculty learners and will address common barriers and challenges faced by faculty members. [Pediatr Ann. 2023;52(7):e266-e272.].
Collapse
|
5
|
Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [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: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
Collapse
Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| |
Collapse
|
6
|
Durham Walker C, McCray GG, Wimes A, Levine D, Rivers D. Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course. Prev Chronic Dis 2023; 20:E41. [PMID: 37200501 DOI: 10.5888/pcd20.220367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.
Collapse
Affiliation(s)
- Carla Durham Walker
- Morehouse School of Medicine, Department of Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA 30310-1495
| | | | | | | | | |
Collapse
|
7
|
Uwishema O. Breaking down barriers in medical education: addressing racism and discrimination. Int J Surg 2023; 109:1068-1069. [PMID: 36917128 PMCID: PMC10389409 DOI: 10.1097/js9.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
| |
Collapse
|
8
|
Falusi O, Chun-Seeley L, de la Torre D, Dooley DG, Baiyewu M, Gborkorquellie TT, Merrill CT, Davis E, Ward MC. Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11305. [PMID: 36999061 PMCID: PMC10043344 DOI: 10.15766/mep_2374-8265.11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity. METHODS The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session. RESULTS A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy. DISCUSSION This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.
Collapse
Affiliation(s)
- Olanrewaju Falusi
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Associate Program Director, Pediatric Residency Program, Children's National Hospital; Medical Director of Advocacy Education, Child Health Advocacy Institute, Children's National Hospital
| | - Lin Chun-Seeley
- Program Lead, Advocacy Education and Community Affairs, Pediatric Resident Health Equity Education, Child Health Advocacy Institute, Children's National Hospital
| | - Desiree de la Torre
- Director, Community Affairs and Population Health Improvement, Child Health Advocacy Institute, Children's National Hospital
| | - Danielle G. Dooley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Medical Director of Community Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Melissa Baiyewu
- Program Manager, Health Promotion and Disease Prevention Programs, Child Health Advocacy Institute, Children's National Hospital
| | - Theiline T. Gborkorquellie
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Assistant Director of Health Equity Education, Pediatric Residency Program, Children's National Hospital; Affiliate Faculty, Child Health Advocacy Institute, Children's National Hospital
| | - Chaya T. Merrill
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Child Health Data Lab, Child Health Advocacy Institute, Children's National Hospital
| | - Elizabeth Davis
- Manager, Government Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Maranda C. Ward
- Assistant Professor and Director of Equity, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences
| |
Collapse
|
9
|
Guerrero Z, Iruretagoyena B, Parry S, Henderson C. Anti-stigma advocacy for health professionals: a systematic review. J Ment Health 2023:1-21. [PMID: 36919957 PMCID: PMC10173949 DOI: 10.1080/09638237.2023.2182421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/21/2022] [Accepted: 11/14/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients. AIMS The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts. METHODS Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out. RESULTS The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general. CONCLUSIONS Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.
Collapse
Affiliation(s)
- Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Barbara Iruretagoyena
- Department of Neurology and Psychiatry, Clínica Alemana Universidad del Desarrollo, Las Condes, Chile
| | - Sarah Parry
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Claire Henderson
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Health Service and Population Research, King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
10
|
Barriers and opportunities for promoting health professions careers among African American students in the Midwest. J Natl Med Assoc 2023; 115:101-118. [PMID: 36775786 DOI: 10.1016/j.jnma.2023.01.007] [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: 02/09/2022] [Revised: 07/28/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023]
Abstract
The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.
Collapse
|
11
|
Childs E, Yoloye K, Bhasin RM, Benjamin EJ, Assoumou SA. Retaining Faculty from Underrepresented Groups in Academic Medicine: Results from a Needs Assessment. South Med J 2023; 116:157-161. [PMID: 36724529 PMCID: PMC9907002 DOI: 10.14423/smj.0000000000001510] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Academic medical centers can improve the quality of care and address health inequities by recruiting and retaining faculty from underrepresented in medicine (URiM) groups; however, the retention of URiM faculty is a barrier to reaching equity-related goals because URiM faculty are less likely to remain in academia and be promoted compared with their peers. As such, the objective of this study was to determine factors that influence the retention of URiM faculty at large academic centers. METHODS One-time, semistructured stay interviews were conducted to assess the experiences of URiM faculty at a large academic hospital in Boston, Massachusetts between October 2016 and April 2017. A qualitative researcher coded the transcripts and identified central themes. RESULTS The participants (N = 17) were 65% Black/African American and 35% Hispanic/Latinx. The median number of years on faculty was 3 years (range 1-33). The themes identified through the stay interviews were grouped into three domains: areas of strength, challenges to advancement, and suggestions for improvement of support. Participants voiced leadership support in their development, the community of patients, URiM networking opportunities, and mentorship as strengths. The barriers to retention included the lack of transparency and trust in their work, a sense of tokenism, organizational management issues, and implicit biases. The suggested ways to improve support included the expanding of initiatives to include all members of groups URiM, continuing URiM faculty development programs, and increasing funding to support advancement. CONCLUSIONS This study underscored the importance of supportive leadership, URiM-specific faculty development programs, networking opportunities, and the recognition of achievements as factors that influence the retention of faculty at a large academic medical center. In addition, participants highlighted the need for strong mentor networks and emphasizing sponsorship.
Collapse
Affiliation(s)
- Ellen Childs
- Division of Health and the Environment, Abt Associates, Rockville, Maryland
| | - Korede Yoloye
- Boston University School of Medicine, Boston, Massachusetts
| | - Robina M. Bhasin
- Boston University School of Medicine, Boston, Massachusetts
- Penn Foster Education Group, Boston, Massachusetts
| | | | | |
Collapse
|
12
|
Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
Collapse
Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
13
|
Carrijo APB, de Moura ALDB, Oliveira ACPE, Rodrigues LV, de Oliveira J, de Castro TF, Torres OM, Poças KC, Deusdará R. Teaching of the Black Population's Health: Anti-Racist Lenses for a Paradigm Shift to Address Racial Inequities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16784. [PMID: 36554663 PMCID: PMC9779734 DOI: 10.3390/ijerph192416784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Health (and its dialectical pair-illness) is determined by multiple factors: social class, educational background, income, occupation, and race/skin color. Racism can directly impact physical and psychological illnesses, with an effect on social conditions of health. This paper discusses: (1) racism as a root cause of health inequities in Brazil and elsewhere, and (2) how students at the University of Brasilia School of Medicine respond to an anti-racist curriculum. We emphasize that an environment of profound exchanges in the teaching-learning process, adopting anti-racism praxis as a competency in the medical curriculum, is a paradigm shift in medical education and future practice.
Collapse
|
14
|
Mavis SC, Caruso CG, Dyess NF, Carr CB, Gerberi D, Dadiz R. Implicit Bias Training in Health Professions Education: A Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:1541-1552. [PMID: 36532396 PMCID: PMC9755456 DOI: 10.1007/s40670-022-01673-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
There is a recurrent call for effective implicit bias (IB) education within health professions education (HPE). We aimed to explore the state of IB education within HPE for clinical learners and IB educators using the Arksey and O'Malley scoping review framework. Thirty publications variable in curricular design met inclusion criteria. No studies assessed learner outcomes at the level of Miller's "shows" or "does" nor reported program evaluation outcomes at the level of Kirkpatrick's "behavior" or "results." Rigorous, theory-guided studies assessing behavioral change, patient care delivery, and patient outcomes are needed to move the field of IB education forward within HPE. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01673-z.
Collapse
Affiliation(s)
- Stephanie C. Mavis
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Medicine at Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Catherine G. Caruso
- Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Nicolle F. Dyess
- Department of Pediatrics, Division of Neonatal Medicine at the University of Colorado, Aurora, CO USA
| | - Cara Beth Carr
- Department of Pediatrics, Division of Neonatology at University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Dana Gerberi
- Mayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY USA
| |
Collapse
|
15
|
Kruse JA, Collins JL, Vugrin M. Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100073. [PMID: 38745633 PMCID: PMC11080399 DOI: 10.1016/j.ijnsa.2022.100073] [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: 12/16/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design Integrative review. Methods The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.
Collapse
Affiliation(s)
| | | | - Margaret Vugrin
- Health Sciences Center- Preston Smith Library, Texas Tech University, United States
| |
Collapse
|
16
|
Kossek EE, Buzzanell PM, Wright BJ, Batz-Barbarich C, Moors AC, Sullivan C, Kokini K, Hirsch AS, Maxey K, Nikalje A. Implementing Diversity Training Targeting Faculty Microaggressions and Inclusion: Practical Insights and Initial Findings. JOURNAL OF APPLIED BEHAVIORAL SCIENCE 2022. [DOI: 10.1177/00218863221132321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the importance of faculty diversity training for advancing an inclusive society, little research examines whether participation improves inclusion perceptions and belongingness. Integrating training and diversity education literature concepts, this study examines the effectiveness of training targeting microaggressions in six STEM (Science, Technology, Engineering, Mathematics) oriented departments at a research-intensive university. Reactions data collected at the end of face-to-face training suggested that participation generally increased inclusion understanding. Self-assessments on inclusion concepts collected from 45% of participants before and three weeks after training suggest participation increases perceptions of the importance of inclusion, microaggression allyship awareness, inclusive behaviors, and organizational identification. Compared to white men, women and minorities reported a greater increase in satisfaction with their department affiliation. While self-assessment results are exploratory and have limitations, analysis suggests that diversity training may enhance knowledge of microaggressions, allyship, inclusive behaviors, and belongingness perceptions. We provide insights for evaluating and implementing diversity training interventions.
Collapse
Affiliation(s)
- Ellen Ernst Kossek
- Krannert School of Management, Purdue University, West Lafayette, IN, USA
| | | | | | | | | | - Charlene Sullivan
- Krannert School of Management, Purdue University, West Lafayette, IN, USA
| | - Klod Kokini
- Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Andrew S. Hirsch
- Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - Kayla Maxey
- Engineering Education, Purdue University, West Lafayette, IN, USA
| | - Ankita Nikalje
- Educational Studies, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
17
|
Muacevic A, Adler JR, Payne-Jameau Y, Wallace E, O’Malley C, Coetzee S, Rajput V. Racial Identity and Relevance in Teaching Clinical Skills and Diagnostic Medicine: A Small/Pilot Focus Session to Engage Medical Educators. Cureus 2022; 14:e31288. [PMID: 36514577 PMCID: PMC9733826 DOI: 10.7759/cureus.31288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Background The relevance and importance of using racial and ethnic categories in medical education is an area requiring richer discussion and engagement among all health professions educators. Objectives There is a genuine need to identify opportunities for leveraging social and structural determinants of health to address health disparities within medical education. We designed a focus session led by a team of diverse clinical and basic science faculty to analyze how medical curricula can integrate racial/ethnic identity as a clinical indicator. We sought to develop strategies to empower medical students and teachers to integrate race as a social rather than a biological construct. Methods The 90-minute focus session included an interactive presentation reviewing the literature related to the use of racial identity in medical education, small group case-based discussions in breakout rooms, a large group debrief, and an optional activity for participants to apply the knowledge gained. The study was approved by the Nova Southeastern University Institutional Review Board (IRB #: 2021-185-NSU). Results Thirty-three participants attended the session at the 2021 International Association of Medical Science Educators (IAMSE) Conference. Eleven (33%) participated in both pre-session and post-session surveys. Survey data revealed significant pre-/post-changes in the knowledge of the advantages and disadvantages of using race in medical education. Qualitative data indicated that participants acquired new knowledge related to the integration of racial identity as a clinical indicator and they were willing to incorporate strategies learned into their teaching. Conclusion Our study data suggests that this focus session equipped faculty with new knowledge and resources to effectively incorporate racial/ethnic identity into medical school curricula to increase awareness of healthcare disparities.
Collapse
|
18
|
Staples H, Frank S, Mullen M, Ogburn T, Hammoud MM, Morgan HK. Improving the Medical School to Residency Transition: Narrative Experiences From First-Year Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1394-1401. [PMID: 35732576 DOI: 10.1016/j.jsurg.2022.06.001] [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: 03/24/2022] [Revised: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We sought to identify first-year obstetrics and gynecology residents' perceptions of both support needed at the medical school to residency transition and readiness to address structural racism and bias at the start of residency training. STUDY DESIGN Residents were recruited by email and social media for 1:1 interviews from March to June 2021. All interviews were completed by a first-year resident or fourth-year medical student using an interview guide created by the authorship team. Recorded interviews were anonymously transcribed and independently reviewed for themes by two authors. SETTING Virtual interviews on the Zoom platform. PARTICIPANTS First-year obstetrics and gynecology residents. RESULTS Interviews were performed with 26 residents, and six themes for support emerged from their narratives: 1) Establishing a residency program community; 2) Relocation resources; 3) Residency preparation content in medical school and residency; 4) Preparedness to address racism and bias; 5) Connecting with peers with similar lived experiences across institutions; and 6) More proactive intentional touchpoints from program leadership early in residency. CONCLUSIONS Resident narratives described multiple crucial opportunities to improve learners' transition to residency. These findings can help define a roadmap of resources and support that residency programs can provide for learners from Match Day through the first few months of residency.
Collapse
Affiliation(s)
- Halley Staples
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Mark Mullen
- Creighton University School of Medicine, Omaha, Nebraska
| | - Tony Ogburn
- University of Texas Rio Grande Valley, Edinburg, Texas
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
19
|
Delk P, Bowling I, Schroeder C, Wilson TE, Wesson M, Wetherill L. An investigation of preceptors' perceptions of behavioral elements of “professionalism” among genetic counseling students. J Genet Couns 2022; 32:325-341. [PMID: 36184900 DOI: 10.1002/jgc4.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
Professionalism in health care is a loosely defined but increasingly studied concept. In genetic counseling, "professional development" expectations for entry-level genetic counselors are described in the "Practice-Based Competencies for Genetic Counselors," but the teaching and evaluation of "professionalism" among genetic counseling students is relatively unexplored. This study investigated program leaders' and clinical supervisors' perceptions of professionalism demonstrated by genetic counseling graduate students to learn about their associated strengths and lapses. Members of program leadership and clinical supervisors at Accreditation Council for Genetic Counseling (ACGC) accredited genetic counseling graduate programs in the United States and Canada were surveyed regarding their observations of genetic counseling students for the years 2017-2019 regarding four domains of professional behavior: integrity, accountability/conscientiousness, teamwork, and patient care, with the Merriam-Webster definition of each behavior provided for each domain. Participants also provided open-text descriptions. Descriptive results showed that the 263 participants found all facets of these professional behaviors to be essential. Patient care had the highest importance and was the domain with the most strengths observed among genetic counseling students. Lapses in professional behavior were identified for self-awareness, time management, and thoroughness. Free responses noted that suggestions or strategies for education about professional behavior from ACGC may improve the professional behavior of genetic counseling students and in turn, genetic counselors. Participants voiced the importance of consideration of diverse professional and cultural backgrounds in setting the expectations for professional behavior among genetic counseling students and genetic counselors so that "professionalism" in genetic counseling is not defined through a White lens. Further investigation into challenges that genetic counseling students face regarding professional behavior during their graduate training and strategies for education about these behaviors will aid in the growth and improvement of the training of genetic counselors. Given the sensitive nature of this topic, portions of this discussion may be triggering for some readers.
Collapse
Affiliation(s)
- Paula Delk
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Isabella Bowling
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Courtney Schroeder
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Theodore E. Wilson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Melissa Wesson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| |
Collapse
|
20
|
Gleicher ST, Chalmiers MA, Aiyanyor B, Jain R, Kotha N, Scott K, Song RS, Tram J, Vuong CL, Kesselheim J. Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula. BMC MEDICAL EDUCATION 2022; 22:696. [PMID: 36175856 PMCID: PMC9520104 DOI: 10.1186/s12909-022-03720-0] [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: 02/01/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. METHODS The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. RESULTS Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. CONCLUSIONS This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.
Collapse
Affiliation(s)
- S T Gleicher
- Neurology, University of Washington, Seattle, USA.
| | - M A Chalmiers
- School of Medicine, University of California San Diego, San Diego, USA
| | - B Aiyanyor
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - R Jain
- Pediatric Hematology/Oncology, University of California San Francisco, San Francisco, USA
| | - N Kotha
- School of Medicine, University of California San Diego, San Diego, USA
| | - K Scott
- Neonatal Intensive Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - J Tram
- School of Medicine, University of California San Diego, San Diego, USA
| | - C L Vuong
- Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, USA
| | - J Kesselheim
- DFCI/BCH Cancer and Blood Disorders Center, Harvard Medical School, Boston, USA
| |
Collapse
|
21
|
Cruz AJS, Abreu LG, da Rocha Mendes S, de Castilho LS, de Abreu MHNG. Association of sociodemographic factors with the prescription pattern of opioids for dental patients: a systematic review. Evid Based Dent 2022:10.1038/s41432-022-0282-7. [PMID: 36068264 DOI: 10.1038/s41432-022-0282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim To evaluate the association of patients' sociodemographic factors (sex, age, ethnicity, income, educational level, living environment and health insurance) with the prescription pattern of opioids provided by oral health practitioners.Methods Observational studies that evaluated the association of patients' sociodemographic factors and the likelihood of receiving an opioid prescription provided by an oral health practitioner were eligible. Electronic searches were conducted in Medline (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey up to March 2021. Two authors independently screened the studies, performed data extraction, and assessed the risk-of-bias using the critical appraisal tools developed by the Joanna Briggs Institute (JBI). Certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Results Eight studies were included in this systematic review. Publication year ranged from 2011 to 2021. Narrative synthesis showed with very low certainty of evidence that younger individuals were more likely to receive a prescription of opioids than older individuals. Regarding the other sociodemographic factors and the prescriptions of opioids in dentistry, the evidence is controversial. Risk of bias was low for most items assessed in the included studies.Conclusion The available evidence suggests that there is an association between patients' sociodemographic factors and the prescription patterns of opioids provided by oral health practitioners.
Collapse
Affiliation(s)
- Alex Junio Silva Cruz
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child´s and Adolescent´s Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
| | - Suellen da Rocha Mendes
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
| | - Lia Silva de Castilho
- Department of Operative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
| | | |
Collapse
|
22
|
Parikh AK, Leschied JR. Microaggressions in our daily workplace encounters: a barrier to achieving diversity and inclusion. Pediatr Radiol 2022; 52:1719-1723. [PMID: 35229186 DOI: 10.1007/s00247-022-05307-9] [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: 10/28/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
Originally coined in 1970 by Dr. Chester Pierce, the term "microaggression" encompasses any subtle insult or informal degradation of a member of any socially marginalized group. While incidents of blatant racism and sexism might be deterred by zero-tolerance policies in the workforce, microaggressions still plague our daily interactions with colleagues and patients alike. In this paper we define and categorize microaggressions using real-world examples, describe their repercussions and provide ways to appropriately respond to microaggressions on a personal and institutional level.
Collapse
Affiliation(s)
- Ashishkumar K Parikh
- Department of Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Jessica R Leschied
- Division of Pediatric Radiology, Department of Radiology, Henry Ford Health System, Detroit, MI, USA.,Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
23
|
Welch TJ. Commentary on The Hate U Give. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:993. [PMID: 34524132 DOI: 10.1097/acm.0000000000004409] [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)
- Tana Jean Welch
- T. J. Welch is associate professor of medical humanities, Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, Florida;
| |
Collapse
|
24
|
The racial and cultural ecology of home and community-based services for diverse older adults. J Aging Stud 2022; 61:101023. [DOI: 10.1016/j.jaging.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
|
25
|
Jivens M, Okafor I, Beverly EA. Osteopathic medical students' understanding of race-based medicine. J Osteopath Med 2022; 122:277-287. [PMID: 35470644 DOI: 10.1515/jom-2021-0228] [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] [Received: 09/14/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Race is a social construct, not a biological or genetic construct, utilized to categorize people based on observable traits, behaviors, and geographic location. Findings from the Human Genome Project demonstrated that humans share 99.9% of their DNA; despite this evidence, race is frequently utilized as a risk factor for diagnosis and prescribing practices. Diagnosing and treating people based on race is known as race-based medicine. Race-based medicine perpetuates biases and diverts attention and resources from the social determinants of health that cause racial health inequities. Minimal research has examined medical students' understanding of race-based medicine. OBJECTIVES The purpose of this study was to assess osteopathic medical students' knowledge, beliefs, and experiences with race-based medicine. METHODS We conducted a descriptive, cross-sectional survey study to assess osteopathic medical students' knowledge, beliefs, and experiences with race-based medicine. An electronic, anonymous survey was distributed to all osteopathic medical students enrolled at a medical school in the Midwest with three campuses during the 2019-2020 academic year. Participants completed a brief demographic questionnaire and the Race-Based Medicine Questionnaire. Descriptive and inferential statistics were conducted utilizing SPSS statistical software version 28.0, and statistical significance was defined as a p<0.05. Open-ended questions were analyzed utilizing content and thematic analyses. RESULTS A total of 438 of the 995 osteopathic medical students consented to participate in the study, for a response rate of 44.0%. Among those participants, 221 (52.0%) reported that they had heard of the term "race-based medicine." Familiarity with the term differed by racial background (χ [2] = 24.598, p<0.001), with Black or African American participants indicating greater familiarity with the term compared to all other races. Of the participants familiar with race-based medicine, 79 (44.4%) provided the correct definition for the term; this finding did not differ by any sociodemographic variable. Part of the way through the questionnaire, all participants were provided the correct definition of "race-based medicine" and asked if they thought medical schools should teach race-based medicine. The majority of participants (n=231, 61.4%) supported the teaching of race-based medicine. Qualitative findings elaborated on participants' support or opposition for teaching race-based medicine in medical school. Those in support explained the importance of teaching historical perspectives of race-based medicine as well as race as a data point in epidemiology and its presence on board examinations, whereas those in opposition believed it contradicted osteopathic principles and practice. CONCLUSIONS Findings showed half of the participants were familiar with race-based medicine, and among those, less than half knew the definition of the term. Highlighting osteopathic philosophy and its focus on the whole person may be one approach to educating osteopathic medical students about race-based medicine.
Collapse
Affiliation(s)
- Morgan Jivens
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ifeoma Okafor
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute, Athens, OH, USA
| |
Collapse
|
26
|
Lui F, Anglin DM. Institutional Ethnoracial Discrimination and Microaggressions among a Diverse Sample of Undergraduates at a Minority-Serving University: A Gendered Racism Approach. EQUALITY, DIVERSITY AND INCLUSION : AN INTERNATIONAL JOURNAL 2022; 41:648-672. [PMID: 35898568 PMCID: PMC9310196 DOI: 10.1108/edi-06-2021-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Ethnoracial minorities report a variety of discriminatory experiences due to systemic racism. Yet, few studies have examined whether gender and race/ethnicity interact to predict institutional discrimination and racial microaggressions through an intersectional approach. Design/methodology/approach A predominantly female (60%), ethnoracial minority (20.8% Black, 31.6% Asian, 30.8% Latina/o, 8.2% White, 6.6% Middle Eastern) sample of 895 undergraduates attending a minority-serving public university in an urban setting completed self-report measures of sociodemographic characteristics, experiences of racial microaggressions, and institutional discrimination. Findings Significant (p<.05) gender × race/ethnicity interaction effects were found in several institutional discrimination domains: Males reported more police/court discrimination overall, but gender differences in police/court discrimination were less pronounced for non-Black vs. Black students. While males tended to report more institutional discrimination than females, the reverse was true for the Middle Eastern group: Middle Eastern females reported institutional discrimination in more domains and more discrimination getting hired than their male counterparts. There was a significant race/ethnicity × gender interaction effect for environmental microaggressions: White males reported more environmental microaggressions than White females, but gender differences were not found in the overall sample. Originality This study is the first to our knowledge to assess the interactive effects of gender and ethnicity on the type of microaggressions experienced in a diverse sample that includes individuals of Middle Eastern descent. The authors highlight the range of discriminatory events that ethnoracially minoritized undergraduates experience, even at a minority-serving institution.
Collapse
Affiliation(s)
- Florence Lui
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deidre M. Anglin
- Department of Psychology, City College of New York and The Graduate Center, City University of New York, New York, NY, USA
| |
Collapse
|
27
|
Greenberg MB, Gandhi M, Davidson C, Carter EB. Society for Maternal-Fetal Medicine Consult Series #62: Best practices in equitable care delivery-Addressing systemic racism and other social determinants of health as causes of obstetrical disparities. Am J Obstet Gynecol 2022; 227:B44-B59. [PMID: 35378098 DOI: 10.1016/j.ajog.2022.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Centers for Disease Control and Prevention define social determinants of health as "the conditions in the places where people live, learn, work, and play" that can affect health outcomes. Systemic racism is a root cause of the power and wealth imbalances that affect social determinants of health, creating disproportionate rates of comorbidities and adverse outcomes in the communities of racial and ethnic minority groups. Focusing primarily on disparities between Black and White individuals born in the United States, this document reviews the effects of social determinants of health and systemic racism on reproductive health outcomes and recommends multilevel approaches to mitigate disparities in obstetrical outcomes.
Collapse
|
28
|
Nwokolo OO, Coombs AAT, Eltzschig HK, Butterworth JF. Diversity and Inclusion in Anesthesiology. Anesth Analg 2022; 134:1166-1174. [PMID: 35130194 DOI: 10.1213/ane.0000000000005941] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In today's world, departments of anesthesiology and professional organizations are rightfully expected to have racial, ethnic, and gender diversity. Diversity and inclusiveness are considered important contributors to an effective and collaborative work environment by promoting excellence in patient care, education, and research. This has been re-emphasized in the racial reckoning in the summer of 2020, and the ongoing health care disparities manifested by the global coronavirus disease 2019 (COVID-19) pandemic. Moreover, the negative consequences of a lack of diversity and inclusion in health care have been shown to impact recruitment, retention, and the economic well-being of academic departments. In the present article, we review the current state of diversity in anesthesiology departments and professional organizations in the United States. We discuss strategies and important approaches to further enhance diversity to promote an inclusive perioperative work environment.
Collapse
Affiliation(s)
- Omonele O Nwokolo
- From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Alice A T Coombs
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, West Hospital, Richmond, Virginia
| | - Holger K Eltzschig
- From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - John F Butterworth
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, West Hospital, Richmond, Virginia
| |
Collapse
|
29
|
Hathaway DB, de Oliveira E Oliveira FHA, Mirhom M, Moreira-Almeida A, Fung WLA, Peteet JR. Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:300-310. [PMID: 34010864 DOI: 10.1097/acm.0000000000004167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives. METHOD The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions. RESULTS Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients. CONCLUSIONS S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.
Collapse
Affiliation(s)
- David B Hathaway
- D.B. Hathaway is attending physician, Department of Psychiatry, Brigham and Women's Hospital, and an instructor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7271-0018
| | - Fabrício H A de Oliveira E Oliveira
- F.H.A. de Oliveira e Oliveira is psychiatrist and a PhD student, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0001-5304-2835
| | - Mena Mirhom
- M. Mirhom is co-director and a post-doctoral clinical fellow, Public Psychiatry Fellowship, Columbia University Department of Psychiatry, New York, New York; ORCID: https://orcid.org/0000-0003-0408-4056
| | - Alexander Moreira-Almeida
- A. Moreira-Almeida is associate professor of psychiatry and director, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0002-9135-2532
| | - Wai Lun Alan Fung
- W.L.A. Fung is research professor, Tyndale University, faculty member, University of Toronto Faculty of Medicine, medical director, Mount Sinai Hospital Wellness Centre, and attending physician, Department of Psychiatry, Mount Sinai Hospital and North York General Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7260-9163
| | - John R Peteet
- J.R. Peteet is associate professor of psychiatry, Harvard Medical School, site director, Fellowship in Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, and attending physician, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5362-1765
| |
Collapse
|
30
|
Montoya-Williams D, Fraiman YS, Peña MM, Burris HH, Pursley DM. Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches. Neoreviews 2022; 23:e1-e12. [PMID: 34970665 PMCID: PMC8796312 DOI: 10.1542/neo.23-1-e1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.
Collapse
Affiliation(s)
| | - Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michelle-Marie Peña
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather H Burris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
31
|
Nguyen BM, Guh J, Freeman B. Black Lives Matter: Moving from passion to action in academic medical institutions. J Natl Med Assoc 2022; 114:193-198. [DOI: 10.1016/j.jnma.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/11/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
|
32
|
Reaves TA, Anderson-Thomas M. Recruitment process that attracts underrepresented students in graduate science and medical education programs. MEDICAL EDUCATION ONLINE 2021; 26:1959283. [PMID: 34351830 PMCID: PMC8344251 DOI: 10.1080/10872981.2021.1959283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
While the population of minorities is increasing in the USA, the numbers obtaining advanced degrees in science/engineering and medicine are minimal. Underrepresented groups make up 19% of the USA labor pool, but less than 6% of science (engineering and medicine) Ph.D.'s. Diversifying the universities and health-care institutions is important to improve the academic experience of faculty, staff, students and everyone regardless of race. To prepare for the approaching diverse environments, educational institutions must create programs that allow underrepresented groups thrive in higher education; and logistically to be sustaining, the recruitment programs must begin at the student level. One approach is the integration of the history (the linking of past-heroes with present-heroes) of science; which is an interesting and important paradigm that can be implemented. As such, a day-long symposium highlighting the life and accomplishments of an African American Scientist; Dr. Ernest Everett Just, Ph.D., is used as a working model to inspire, educate on admission requirements, and to recruit into graduate science and medical programs.
Collapse
Affiliation(s)
- Titus A. Reaves
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Meghan Anderson-Thomas
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
33
|
Saymuah Stone S, Bell C, Peoples A, Sandhu M, Alzouhayli S, Akers KG. Racism in medicine: A qualitative study on the impact of discussion among medical students. MEDEDPUBLISH 2021. [DOI: 10.12688/mep.17424.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities. Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions. Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001). Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education. Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.
Collapse
|
34
|
Solomon SR, Atalay AJ, Osman NY. Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1513-1517. [PMID: 34292192 DOI: 10.1097/acm.0000000000004251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.
Collapse
Affiliation(s)
- Sonja R Solomon
- S.R. Solomon is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alev J Atalay
- A.J. Atalay is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora Y Osman
- N.Y. Osman is assistant professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
35
|
Making 'Good Trouble': Time for Organized Medicine to Call for Racial Justice in Medical Education and Health Care. Am J Med 2021; 134:1203-1209. [PMID: 34062146 DOI: 10.1016/j.amjmed.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
"Never, ever be afraid to make some noise and get in good trouble, necessary trouble." - Representative John Lewis It is time now for organized medicine to make "good trouble" and call for racial justice in medical education and health care. It is also time to have an honest confrontation with reality in order to bring about racial healing and become anti-racist organizations. Using a racial justice framework, 4 elements described here can chart our course. Organized medicine must come together in solidarity to make "good trouble" and fight collectively for racial justice so that every community we serve can achieve their full health potential and achieve racial equity-that is, giving people what they need to enjoy full, healthy lives regardless of race.
Collapse
|
36
|
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
| |
Collapse
|
37
|
Miller DT, Chen EH. Helping the learner to deal with microaggressions in the workplace: Individual, programmatic, and institutional-level responses. AEM EDUCATION AND TRAINING 2021; 5:S140-S143. [PMID: 34616989 PMCID: PMC8480475 DOI: 10.1002/aet2.10663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/08/2021] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
Microaggressions are frequently experienced by learners in the workplace and can create a hostile learning environment. Many faculty educators lack formal training in supporting their learners after incidents of microaggressions. Supervising faculty should be able to recognize and respond to microaggressions against trainees in the clinical environment. In this commentary, we will briefly review the definition of microaggressions, summarize the impact of microaggressions on trainees, provide a framework for managing microaggressions on an individual level when the patient offends the learner, and highlight strategies to mitigate microaggressions on a programmatic and institutional level.
Collapse
Affiliation(s)
- Danielle T. Miller
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Esther H. Chen
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| |
Collapse
|
38
|
Corsino L, Fuller AT. Educating for diversity, equity, and inclusion: A review of commonly used educational approaches. J Clin Transl Sci 2021; 5:e169. [PMID: 34733545 PMCID: PMC8532179 DOI: 10.1017/cts.2021.834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 01/29/2023] Open
Abstract
Diversity, equity, and inclusion (DEI) are fundamentally important concepts for advancing clinical and translational science (CTS) education. CTS education spans a wide range of disciplines from cell biology to clinical and community/population research. This large scope both in terms of intellectual areas and target groups requires an understanding of existing educational approaches for DEI as we translate DEI from mere concepts into equitable actions within CTS education. In this review, we provide the readers with the most common DEI educational approaches, including cultural humility, bias training, and improving mentoring to diversify the workforce. DEI educational materials can achieve maximal success and long-term impact when implemented as institutional-wide interventions, and the materials are not seen as an isolated or independent curriculum. Approaches, strategies, and programs to achieve this are many. However, many questions remain unanswered about what the best approach, strategies, and programs are to be implemented in institutional-wide education that will be embedded in CTS education.
Collapse
Affiliation(s)
- Leonor Corsino
- Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke School of Medicine, Durham, North Carolina, USA
- Duke Clinical and Translational Science Institute, Community-Engaged Research Initiative Core, Duke School of Medicine, Durham, North Carolina, USA
| | - Anthony T. Fuller
- Department of Neurosurgery, Division of Global Neurosurgery and Neurology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Clinical and Translational Science Institute, Center for Pathway Programs, Duke School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
39
|
Loe IM, Froehlich TE, Edrees HH, Spinks-Franklin A. Racism as an Adverse Childhood Experience: An Interactive Workshop to Train Pediatricians to Address Racism in Clinical Care. J Dev Behav Pediatr 2021; 42:502-511. [PMID: 34191762 DOI: 10.1097/dbp.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to address critical gaps in pediatric medical education by developing and evaluating an interactive educational workshop on racism as an adverse childhood experience (ACE). METHODS A team of developmental-behavioral pediatrics professionals used a best-practice curriculum development model of Kern's 6 steps to develop the workshop curriculum. Based on a targeted needs assessment, goals and objectives to address the topics of race and racism in clinical practice were developed. A variety of educational strategies (e.g., audience polls, videos, didactic presentations, experiential activities, and peer-guided case-based discussion and practice) were used to appeal to varied learning styles. Selection of strategies was guided by self-determination theory, an adult learning model that addresses the needs of autonomy, competence, and relatedness. The workshop was implemented at 2 national pediatric meetings and evaluated using participant polls and written program evaluation. RESULTS The workshop curriculum was well-received. Participants endorsed improvements in comfort level in talking about race/racism and demonstrated a significant change in preparation or comfort level for skills-based activities, including counseling families and offering resources to address experiences with racism, postworkshop. Participants endorsed intent to change clinical practice by discussing the issues of race and indicated a desire to receive additional training. CONCLUSION An interactive educational workshop on racism as an ACE was effective in improving pediatric professionals' comfort level and self-rated skills. Desire for a longer educational session suggests receptivity to longitudinal approaches. Replication and refinement of the educational workshop could clarify effective components of this approach. We advocate for longitudinal training curricula that incorporate observable behavior change and skills to increase and further evaluate the impact. Health care provider education and training to implement antiracism efforts in clinical encounters with patients and families can serve as an entry point to the complex process of addressing racism at multiple levels in health care.
Collapse
Affiliation(s)
- Irene M Loe
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Tanya E Froehlich
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Hanein H Edrees
- Division of Developmental and Behavioral Sciences, Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Adiaha Spinks-Franklin
- Section of Developmental Pediatrics, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| |
Collapse
|
40
|
McKillip KM, Moss RFF. Power, Silence, and Debriefing: Hidden Harms When Palliative Teams Encounter Racism. J Pain Symptom Manage 2021; 61:1311-1315. [PMID: 33549738 DOI: 10.1016/j.jpainsymman.2021.01.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Kathleen M McKillip
- Creighton University CHI Health Clinic (K.M.M, R.F.F.M.), Omaha, Nebraska, USA. The author Rev. Florence "FLOMO" Moss is now affiliated with Ocean Ministries based in Spring Hill, Florida and is a Chaplain in the United States Army Reserves..
| | - Rev Florence Flomo Moss
- Creighton University CHI Health Clinic (K.M.M, R.F.F.M.), Omaha, Nebraska, USA. The author Rev. Florence "FLOMO" Moss is now affiliated with Ocean Ministries based in Spring Hill, Florida and is a Chaplain in the United States Army Reserves
| |
Collapse
|
41
|
Affiliation(s)
- Shirlene Obuobi
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Monica B Vela
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Brian Callender
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA; Stevanovich Institute on the Formation of Knowledge, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
42
|
Lim GHT, Sibanda Z, Erhabor J, Bandyopadhyay S. Students' perceptions on race in medical education and healthcare. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:130-134. [PMID: 33415681 PMCID: PMC7790028 DOI: 10.1007/s40037-020-00645-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 05/23/2023]
Abstract
Major racial disparities continue to exist in our healthcare education, from the underrepresentation of ethnic minorities when teaching about clinical signs to health management in primary and secondary care. A multi-centre group of students discuss what needs to change in medical education to cultivate physicians who are better prepared to care for patients of all backgrounds. We argue that the accurate portrayal of race in medical education is a vital step towards educating medical students to consider alternative explanations to biology when considering health inequities.
Collapse
Affiliation(s)
- Guan Hui Tricia Lim
- University College London Medical School, University College London, London, UK
| | | | | | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| |
Collapse
|
43
|
Abstract
Microaggression as a concept has received significant attention in the popular media as well as in literature. The concept has yet to be addressed, however, in the context of health care education or academia. In this article, current thoughts on racial microaggressions are reviewed with a focus on implications for nursing faculty and academia. The role of implicit bias and microaggressions on faculty diversity and promotion is discussed, and recommendations for next steps are reviewed.
Collapse
Affiliation(s)
- Kumhee Ro
- About the Authors Kumhee Ro, DNP, ARNP, is an assistant professor, Seattle University College of Nursing, Seattle, Washington. Joshua Villarreal, PharmD, MPA, BCPS, is a clinical pharmacist at the University of Washington Medical Center, Seattle, Washington. For more information, contact Dr. Ro at
| | | |
Collapse
|
44
|
Antón-Solanas I, Huércanos-Esparza I, Hamam-Alcober N, Vanceulebroeck V, Dehaes S, Kalkan I, Kömürcü N, Coelho M, Coelho T, Casa-Nova A, Cordeiro R, Ramón-Arbués E, Moreno-González S, Tambo-Lizalde E. Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1357. [PMID: 33540907 PMCID: PMC7908137 DOI: 10.3390/ijerph18031357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed.
Collapse
Affiliation(s)
- Isabel Antón-Solanas
- Department of Physiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Calle Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Isabel Huércanos-Esparza
- Faculty of Health Sciences, Universidad San Jorge, Autovía Mudéjar, km. 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (E.R.-A.); (S.M.-G.)
| | - Nadia Hamam-Alcober
- Servicio Aragonés de Salud, Miguel Servet Women’s and Children’s Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain;
| | - Valérie Vanceulebroeck
- Department of Nursing, AP University of Applied Sciences and Arts, Lange Nieuwstraat 101, 2000 Antwerpen, Belgium; (V.V.); (S.D.)
| | - Shana Dehaes
- Department of Nursing, AP University of Applied Sciences and Arts, Lange Nieuwstraat 101, 2000 Antwerpen, Belgium; (V.V.); (S.D.)
| | - Indrani Kalkan
- Faculty of Health Sciences, Halit Aydin Campus 38, Istanbul Aydin University, Sefaköy-Küçükçekmece, Istanbul 34295, Turkey; (I.K.); (N.K.)
| | - Nuran Kömürcü
- Faculty of Health Sciences, Halit Aydin Campus 38, Istanbul Aydin University, Sefaköy-Küçükçekmece, Istanbul 34295, Turkey; (I.K.); (N.K.)
| | - Margarida Coelho
- Instituto Politécnico de Portalegre, School of Education and Social Science, Praça do Município 11, 7300-110 Portalegre, Portugal; (M.C.); (T.C.)
| | - Teresa Coelho
- Instituto Politécnico de Portalegre, School of Education and Social Science, Praça do Município 11, 7300-110 Portalegre, Portugal; (M.C.); (T.C.)
| | - Antonio Casa-Nova
- Instituto Politécnico de Portalegre, School of Health Sciences, Praça do Município 11, 7300-110 Portalegre, Portugal; (A.C.-N.); (R.C.)
| | - Raul Cordeiro
- Instituto Politécnico de Portalegre, School of Health Sciences, Praça do Município 11, 7300-110 Portalegre, Portugal; (A.C.-N.); (R.C.)
| | - Enrique Ramón-Arbués
- Faculty of Health Sciences, Universidad San Jorge, Autovía Mudéjar, km. 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (E.R.-A.); (S.M.-G.)
| | - Sergio Moreno-González
- Faculty of Health Sciences, Universidad San Jorge, Autovía Mudéjar, km. 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (E.R.-A.); (S.M.-G.)
| | - Elena Tambo-Lizalde
- Instituto de Investigación Sanitaria, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| |
Collapse
|
45
|
Foster KE, Johnson CN, Carvajal DN, Piggott C, Reavis K, Edgoose JYC, Elliott TC, Gold M, Rodríguez JE, Washington JC. Dear White People. Ann Fam Med 2021; 19:66-69. [PMID: 33431395 PMCID: PMC7800738 DOI: 10.1370/afm.2634] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022] Open
Abstract
We are living in unprecedented times. While the world is grappling with COVID-19, we find the horrors of racism looming equally large as we, yet again, confront lurid deaths in the center of the news cycle of Black and brown people from police bias and brutality. Those of us who have been championing antiracism and justice work and bearing the burden of the "minority tax" have been overwhelmed by sudden asks from our well-intentioned White colleagues of how to best respond. In the tone of the Netflix series, "Dear White People," we further emphasize that we are not alone in trying to reach out to you, our White colleagues and leaders. Please hear our story and heed our call to action.
Collapse
Affiliation(s)
- Krys E Foster
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Diana N Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cleveland Piggott
- Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Kristin Reavis
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Y C Edgoose
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Marji Gold
- Department of Family and Social Medicine, Albert Einstein College of Medicine Bronx, New York
| | | | | |
Collapse
|
46
|
Abuelezam NN, Castro Samayoa A, Dinelli A, Fitzgerald B. Naming racism in the public health classroom. PLoS One 2020; 15:e0243560. [PMID: 33296432 PMCID: PMC7725293 DOI: 10.1371/journal.pone.0243560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The discussion of racism within undergraduate public health classrooms can be highly influenced by local and national conversations about race. We explored the impact of local and national events on students' ability to name racism on a public health exam highlighting the impact of racism on maternal and infant health disparities for Black mothers. METHODS We undertook this research within the context of an undergraduate introductory public health course at a primarily white institution in the Northeastern part of the United States. A qualitative content analysis of undergraduate student responses to a final exam question soliciting the importance of racism to health outcomes among Black mothers in the United States was undertaken. ANOVA tests were run to assess differences on naming racism, using semantic alternatives, and providing alternative explanations during three main time periods: prior to the election of the 45th president of the United States (pre-Trump), after the election (post-Trump), and after a nationally recognized racist campus incident. RESULTS Between the pre- and post-Trump periods we see no differences in naming racism or providing alternative explanations. We do see a reduction in the proportion of students providing semantic alternatives for racism in the post-Trump period (32.2 vs. 25.2%, p = 0.034). After the racist campus incident, we see increases in the proportion of students naming race (53.6 vs. 73.8%, p = 0.021) and decreases in the proportion providing an alternative explanation (43.1 vs. 12.9%, p = 0.004), but no differences in the proportion of students who used semantic alternatives. DISCUSSION This work lends itself to our understanding of how local climate affects public health teaching and may also influence students' learning about important social and structural determinants of health. National and local climate should frame and guide public health teaching.
Collapse
Affiliation(s)
- Nadia N. Abuelezam
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, United States of America
| | - Andrés Castro Samayoa
- Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, United States of America
| | - Alana Dinelli
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, United States of America
| | - Brenna Fitzgerald
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, United States of America
| |
Collapse
|
47
|
Hudson B, Campbell KM. Does Criticism of Minority Faculty Result From a Lack of Senior Leadership Training and Accountability? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1792. [PMID: 33234825 DOI: 10.1097/acm.0000000000003735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Briana Hudson
- Master's of public health student, Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kendall M Campbell
- Master's of public health student, Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| |
Collapse
|
48
|
Manzi J, Casapulla S, Kropf K, Baker B, Biechler M, Finch T, Gerth A, Randolph C. Responding to Racism in the Clinical Setting: A Novel Use of Forum Theatre in Social Medicine Education. THE JOURNAL OF MEDICAL HUMANITIES 2020; 41:489-500. [PMID: 31984454 DOI: 10.1007/s10912-020-09608-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Issues of race have traditionally been addressed in medical school curricula in a didactic manner. However, medical school curricula often lack adequate opportunity for the application of learning material relating to race and culture. When confronted with acts of racism in clinical settings, students are left unprepared to respond appropriately and effectively. Forum Theatre offers a dynamic platform by which participants are empowered to actively engage with and become part of the performance. When used in an educational context, Forum Theatre can be a powerful tool for students to interact with a wide variety of social issues. This paper describes the process by which one medical school designed a workshop in the Forum Theatre style to equip students to respond to racism observed in clinical settings. Based on real student experiences, the Responding to Racism in the Clinical Setting workshop was designed to give students an opportunity to combine cultural humility, communication theory and conflict resolution skills in order to prepare for interactions in clinical stages of medical education. As a result of workshop evaluations, surveys, and written reflections, the authors propose that Forum Theatre is a novel teaching modality for incorporating issues of race and culture into medical curriculum.
Collapse
Affiliation(s)
- Joel Manzi
- Ohio University Heritage College of Osteopathic Medicine-Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH, 44122, USA.
| | - Sharon Casapulla
- Office of Rural and Underserved Programs, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Katherine Kropf
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Brandi Baker
- Office of Inclusion, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Merri Biechler
- Theater Division, School of Dance, Film, and Theater, Ohio University, Athens, OH, USA
| | - Tiandra Finch
- Ohio University Heritage College of Osteopathic Medicine-Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH, 44122, USA
| | - Alyssa Gerth
- Ohio University Heritage College of Osteopathic Medicine-Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH, 44122, USA
| | - Christina Randolph
- Ohio University Heritage College of Osteopathic Medicine-Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH, 44122, USA
| |
Collapse
|
49
|
Parsons S. Addressing Racial Biases in Medicine: A Review of the Literature, Critique, and Recommendations. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:371-386. [DOI: 10.1177/0020731420940961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.
Collapse
Affiliation(s)
- Sharon Parsons
- School of Doctoral Studies, Grand Canyon University, West Palm Beach, Florida, USA
| |
Collapse
|
50
|
Lewis LD, Steinert Y. How Culture Is Understood in Faculty Development in the Health Professions: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:310-319. [PMID: 31599755 DOI: 10.1097/acm.0000000000003024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To examine the ways in which culture is conceptualized in faculty development (FD) in the health professions. METHOD The authors searched PubMed, Web of Science, ERIC, and CINAHL, as well as the reference lists of identified publications, for articles on culture and FD published between 2006 and 2018. Based on inclusion criteria developed iteratively, they screened all articles. A total of 955 articles were identified, 100 were included in the full-text screen, and 70 met the inclusion criteria. Descriptive and thematic analyses of data extracted from the included articles were conducted. RESULTS The articles emanated from 20 countries; primarily focused on teaching and learning, cultural competence, and career development; and frequently included multidisciplinary groups of health professionals. Only 1 article evaluated the cultural relevance of an FD program. The thematic analysis yielded 3 main themes: culture was frequently mentioned but not explicated; culture centered on issues of diversity, aiming to promote institutional change; and cultural consideration was not routinely described in international FD. CONCLUSIONS Culture was frequently mentioned but rarely defined in the FD literature. In programs focused on cultural competence and career development, addressing culture was understood as a way of accounting for racial and socioeconomic disparities. In international FD programs, accommodations for cultural differences were infrequently described, despite authors acknowledging the importance of national norms, values, beliefs, and practices. In a time of increasing international collaboration, an awareness of, and sensitivity to, cultural contexts is needed.
Collapse
Affiliation(s)
- Lerona Dana Lewis
- L.D. Lewis was postdoctoral fellow, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada, at the time this work was completed. Y. Steinert is professor of family medicine and health sciences education, director of the Institute of Health Sciences Education, and the Richard and Sylvia Cruess Chair in Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|