Epistemic Peerhood as a Model To Improve Gender-Affirming Care in Medical Education

Issue: Inadequate training around gender-affirming care is a critical gap in health care and medical education that causes disparities and leads to injury for transgender, nonbinary, and other gender-diverse patients. In contrast to this widespread provider knowledge gap, gender-diverse patients bring critical knowledge from their own experiences to health care. Embracing varied epistemologies, or sources of knowledge, within medical education has the potential to enhance gender-affirming care by intentionally placing value on the lived experiences and emphasizing the credibility of gender-diverse patients. Evidence: In this article, the authors endorse a model of epistemic peerhood in which the embodied knowledge of gender-diverse patients and the authoritative knowledge of providers are each valued for their contribution to care. The authors reflect on experiences developing gender-affirming healthcare curricula and how medical education has not yet adequately addressed gender-diverse care without embracing community knowledge. Implications: The authors identify three vital areas to integrate epistemic peerhood in medical training to address gaps in gender-affirming care: (1) collaborative student training methods that reflect embodied knowledge in the absence of, or in addition to, clinical expertise on gender-affirming care; (2) sustainable partnerships between academic programs and gender-diverse communities that foster continuous engagement from collaborators with lived experience; and (3) broad community input about best practices for representing gender diversity in patient simulation. Embracing epistemic peerhood in each of these areas would result in broader gender-diverse community representation and leadership in medical education, which would ultimately strengthen gender-affirming healthcare training.

The Early Effects of the COVID-19 Pandemic on Pediatric Resident Education: A National Assessment

PURPOSE

Residency programs must ensure resident competence for independent practice. The COVID-19 pandemic disrupted healthcare delivery, impacting pediatric residencies. This study examines the impact on pediatric resident education.

METHODS

The authors conducted a mixed methods national survey of pediatric residency program directors (PDs) from May- July 2020. Data analysis included descriptive statistics, χ², Wilcox rank sum tests. Multivariable modeling identified factors associated with resident preparation for more senior roles. Thematic analysis was performed on open-ended questions about PD COVID-19 pandemic recommendations to peers, Accreditation Council for Graduate Medical Education and American Board of Pediatrics.

RESULTS

Response rate was 55% (110/199). PDs reported the COVID-19 pandemic negatively affected inpatient (n= 86, 78.2%), and outpatient education (n=104, 94.5%), procedural competence (n=64; 58.2%), and resident preparation for more senior roles (n= 50, 45.5%). In bivariate analyses, increasingly negative impacts on inpatient and outpatient education were associated with an increasingly negative impact on resident preparation for more senior roles (p=0.03, p=0.008), these relationships held true in multivariable analysis. Qualitative analysis identified 4 themes from PD recommendations: 1) Clear communication from governing bodies and other leaders; 2) Flexibility within programs and from governing bodies; 3) Clinical exposure is key for competency development; 4) Online platforms are important for education, communication, and support.

CONCLUSIONS

The COVID-19 pandemic negatively impacted inpatient and outpatient education. When these were more negatively impacted, resident preparation for more senior roles was worse. Highlighting the importance of competency based medical education to tailor experiences ensuring each resident is competent for independent practice.

WHAT'S NEW

The COVID-19 pandemic negatively impacted inpatient and outpatient clinical education which negatively impacted resident preparation for more senior roles. This highlights the importance of competency based medical education to ensure each graduating resident is competent for independent practice.

Board certification of professional chaplains: a qualitative study of stakeholder perspectives

Many professional chaplaincy organizations in the United States have board certified healthcare chaplains since the 1920s and documented how they have adapted their process as the profession has grown. In 2019, the Association of Professional Chaplains and the National Association of Catholic Chaplains sought the perspectives of key stakeholders about professional chaplaincy board certification. This study reports the results from 50 semi-structured interviews with certification candidates, certification committee members, and chaplaincy managers in the United States. Participants discussed the preparation of the certification application, the certification interview, the ease and difficulty of certification competencies, and the evolving workforce. This study demonstrated divergent views on many aspects of board certification, but participants predominately respected and valued the process. Chaplains with varying levels of experience discussed how board certification strengthens multidisciplinary respect and collaboration. Participants reported difficulties with competencies that required translating between theory and practice.

[Injuries to the rectum in diagnostic and therapeutic measures (author's transl)]

From 1955 to 1973, 28 anus praeter or rectal perforations were observed in the Chirurgische Universitätsklinik Erlangen. Ten of these patients died. The perforation of the intestine was already noted at the time of injury in 14, in 14 it deteriorated until a peritonitis at the end of three days on the average required laparotomy. The perforations arose mainly through rectoscopy or enemas. Such everday measures need care, in particular to stop the manipulation when the patient complains of pain. If there is the slightest suspicion, visualize the point of injury with a water soluble contrast medium.