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Ayash C, Raad N, Finik J, Taoube J, Gorayeb S, Abouhala S, Nourredine S, Jdid M, Aragones A, Gany FM. Perspectives on Human Papilloma Virus Vaccination Barriers, Knowledge and Beliefs, and Practices: Providers Serving Arab-American Populations. J Community Health 2024; 49:127-138. [PMID: 37555910 DOI: 10.1007/s10900-023-01248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 08/10/2023]
Abstract
Little is known of HPV vaccination (HPVV) recommendation practices among healthcare providers who treat the Arab American community. Evidence indicates that HPVV patient uptake is low in this population. A survey was administered to healthcare providers (N = 46, 63% response rate) who treated ≥ 5% Arab American patients aged 9-26 years in areas of New York City and New Jersey with large Arab American populations. They were asked about barriers to HPVV recommendation and uptake among their Arab American patients. Providers (Doctors of Medicine and Osteopathy, Nurse Practitioners, and Physician Assistants) mostly worked in pediatrics (41%), primary care/internal medicine (26%), obstetrics/gynecology (20%), and family medicine (15%). Most (91%) were confident in their ability to effectively counsel their patients on HPVV. The most frequent provider-reported barriers to administering the HPVV to Arab American patients were patient cultural/religious practices (reported by 67%) and patient and provider difficulties with insurance reimbursement (44%). Most providers (84%) agreed that organizations/programs to increase HPVV uptake among Arab American patients were needed. Providers felt that HPVV uptake could be increased with educational materials in the patients' native languages ("very useful," 81%) and provider cultural competency training ("very useful," 65%). In responses to open-ended questions, cultural and religious HPVV barriers were a salient topic, as were linguistic barriers and provider burdens related to HPVV costs and regulations. HPVV uptake could potentially be improved with Arabic language education materials, provider education that is culturally and linguistically tailored to the Arab American community, and policies to address HPVV financial and regulatory burdens.
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Affiliation(s)
- Claudia Ayash
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Noor Raad
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Jackie Finik
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Jana Taoube
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Sandra Gorayeb
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Siwaar Abouhala
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Sabine Nourredine
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Maria Jdid
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Abraham Aragones
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA
| | - Francesca M Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Avenue, New York, NY, 10017, USA.
- Department of Medicine, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
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Großkreutz C, Gürbüz B, Borde T, Rancourt RC, Henrich W, David M, Seidel V. Equal Alternatives or Lower Standards for Immigrant Women-Analyzing Obstetric Care for Immigrant Women in Berlin Within the Framework of Cultural Health Capital. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01732-0. [PMID: 37581765 DOI: 10.1007/s40615-023-01732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
In obstetric clinics in Berlin, Germany, more than half of the women are immigrants. The main objective of the qualitative study was to explore the staff's experiences with obstetric care for immigrants and juxtapose it with the immigrants' comments on their birth experiences. We analyze potential differences along the framework of a cultural health capital (CHC). Between May and August 2017, semi-structured interviews were carried out with 17 obstetricians and 17 midwives at four obstetric clinics in Berlin. The verbally transcribed interview material was subjected to a qualitative content analysis according to Mayring. Furthermore, a secondary data from an interview study was analyzed in the purpose of providing some insight into the practitioner study participant perspective. Between January and May 2017, in the postpartum ward at the Berlin Charité Campus Virchow Clinic, an interview study guided by the migrant-friendly maternity care questionnaire was conducted among 410 migrant and non-migrant women. For this study, the free-text comments on the pregnancy care were analyzed. The staff interviewees identified language barrier and legal status as risk factors for the late onset of obstetric care. CHC functioning potentially as alternatives to the established health care structures were voiced. Strong family ties among immigrant families bear a high potential for support. Gratefulness was voiced by the staff and immigrant patients as a source of satisfaction with care. Our study shows that obstetric care for immigrant women remains a challenge. CHC of immigrant women might partially compensate for exclusion.
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Affiliation(s)
- Claudia Großkreutz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Burcu Gürbüz
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Rebecca C Rancourt
- Division of 'Experimental Obstetrics', Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias David
- Clinic of Gynecology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Vera Seidel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
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Chiropractic Educators Research Forum. Preparing for the Future: Diversity in Chiropractic Education: Chiropractic Educators Research Forum (CERF), December 4, 2021. J Chiropr Educ 2022; 36:194-8. [PMID: 35522795 DOI: 10.7899/JCE-21-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This conference was convened by the Chiropractic Educators Research Forum (CERF) on December 4, 2021. This meeting provided a forum for the presentation of scholarly works in education theory and practice. This conference specifically focused on research related to diversity, equity, and inclusion. During the December 2021 CERF meeting, presenters and panelists took an in depth look at how chiropractic programs work to address diversity issues in the changing landscape of healthcare and to address the needs of the world population.
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Adetoye M, Gold K. Race and Gender Disparities Among Leadership in Academic Family Medicine. J Am Board Fam Med 2022:jabfm.2022.AP.220122. [PMID: 36096662 DOI: 10.3122/jabfm.2022.ap.220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND As the United States moves closer to a majority-minority, and a nearly equal male to female population, we should see a similar shift in the composition of leadership in the workplace. Family Medicine, while attempting to close the gaps, continues to fall short in producing women and minority leaders. METHODS: The demographic traits of Association of Departments of Family Medicine (ADFM) chairs in medical education institutions in the United States and Canada were analyzed. RESULTS: The majority of those in chair positions were male (67%) and White (53%) non-Hispanic. Male chairs have been in positions significantly longer than females (average 9 years and 6 years, respectively). There was also a significant difference between chairs in public versus private schools-public, that is, chairs at public institutions had a much longer average time of 9 years in current position compared with those in private institutions had an average of 5 years. While the comparison was not significant, 46% of those that self-reported as non-White held chair positions at private schools compared with 28% of those that self-reported as White. CONCLUSIONS: Despite the availability of leadership pathways, women and underrepresented minorities continue to be underrepresented in these positions. Future research would benefit from a more extensive evaluation of different characteristics such as disability, gender identity and sexual orientation.
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Affiliation(s)
- Mercy Adetoye
- From Department of Family Medicine, University of Michigan Medical School, Chelsea, MI (MA, KG).
| | - Katherine Gold
- From Department of Family Medicine, University of Michigan Medical School, Chelsea, MI (MA, KG)
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Barrett DL, Supapannachart KJ, Caleon RL, Ragmanauskaite L, McCleskey P, Yeung H. Interactive Session for Residents and Medical Students on Dermatologic Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients. MedEdPORTAL 2021; 17:11148. [PMID: 33907709 PMCID: PMC8063631 DOI: 10.15766/mep_2374-8265.11148] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/26/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Despite increasing emphasis on LGBTQ health in medical education, evidence-based training on LGBTQ patient care in dermatology is lacking. We designed an interactive online didactic session on dermatologic care of LGBTQ patients for medical students and dermatology residents. METHODS Session content was based on continuing medical education articles and incorporated preexisting LGBTQ-inclusive policies, environments, and videos. We implemented the session via a web-based videoconferencing platform as part of a preexisting resident lecture series. We began with a 90-minute lecture on LGBTQ health care disparities and dermatologists' roles, best practices for providing inclusive care, and dermatologic health concerns and screening recommendations in LGBTQ populations. To solidify knowledge and promote practice of learned skills, a 30-minute interactive role-playing session followed where participants acted as observer, patient, or provider in three distinct clinical scenarios pertaining to dermatologic care of LGBTQ patients. Participants completed baseline and follow-up surveys, which included a psychometrically validated clinical skills scale and an ad hoc knowledge assessment. RESULTS Baseline and follow-up scores from the clinical skills scale increased overall (0.7; 95% CI, 0.5-0.9; p < .001), in self-reported clinical preparedness (1.1; 95% CI, 0.5-1.6; p = .001), and in basic knowledge (0.8; 95% CI, 0.3-1.4; p = .003). DISCUSSION An online interactive didactive session on dermatological care of LGBTQ patients increased participants' clinical preparedness and basic knowledge. Implementation of similar sessions at other institutions can improve gaps in preparing residents and medical students in dermatological care of LGBTQ patients.
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Affiliation(s)
- Devon L. Barrett
- Third-Year Medical Student, Department of Dermatology, Emory University School of Medicine
| | | | - Ramoncito L. Caleon
- Third-Year Medical Student, Department of Dermatology, Emory University School of Medicine
| | - Laura Ragmanauskaite
- Resident, Department of Dermatology, University of Tennessee Health Science Center
| | | | - Howa Yeung
- Assistant Professor, Department of Dermatology, Emory University School of Medicine; Associate Professor, Regional Telehealth Service, VA Southeast Network VISN 7
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Ortega P, López-Hinojosa I, Park YS, Girotti JA. Medical Spanish Musculoskeletal and Dermatologic Educational Module. MedEdPORTAL 2021; 17:11071. [PMID: 33473381 PMCID: PMC7809932 DOI: 10.15766/mep_2374-8265.11071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/26/2020] [Indexed: 05/28/2023]
Abstract
INTRODUCTION While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts. METHODS An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels. RESULTS Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups. DISCUSSION An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).
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Affiliation(s)
- Pilar Ortega
- Clinical Assistant Professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine
| | | | - Yoon Soo Park
- Director of Health Professions Education Research, Massachusetts General Hospital, Harvard Medical School
| | - Jorge A. Girotti
- Assistant Professor, Department of Medical Education, and Former Director, Hispanic Center of Excellence, University of Illinois College of Medicine
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Rosa-Vega J, Carlo E, Rodríguez-Ochoa A, Hernández-Agosto J, Santiago Quiñones D, Cabrera-Candelaria D, Rodríguez-Díaz CE, Melin K. Educational intervention to improve pharmacist knowledge to provide care for transgender patients. Pharm Pract (Granada) 2020; 18:2061. [PMID: 33343770 PMCID: PMC7739511 DOI: 10.18549/pharmpract.2020.4.2061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Most pharmacists have not received formal training or education in the
provision of care for transgender patients. Nonetheless, pharmacists have
the potential to be valuable partners in the care of transgender patients,
and a continuing education course might be valuable in addressing this
knowledge gap. Objective: The aim of this study was to examine the impact of a three-hour continuing
education course in improving the knowledge of pharmacists to provide
pharmaceutical care for transgender patients. Methods: A quasi-experimental, one-group pre-test/post-test study design was used to
measure the impact of a three-hour continuing pharmacy education course on
the knowledge of pharmacists on transgender care. The course was divided
into three units: (1) Transgender Patient Care Introduction, (2) General
Health Issues of Transgender Patients, and (3) Gender Affirming Hormone
Therapy. A total of 68 pharmacists participated in the study, of which 54
completed both the pre- and post-test. An ANOVA was used to compare
differences in knowledge in the group before and after the educational
intervention. Results: The majority of the participating pharmacists were cisgender, heterosexual
women who had not received any formal training related to transgender care.
Participants demonstrated the largest increase in execution score in the
third unit, with a percent improvement of 25.22% (pre-test
45.06%, post-test 70.28%; p<0.001). The average total
execution score was 52.15% in the pre-test and 72.89%
(p< 0.001) in the post-test. Conclusions: Pharmacists benefited from a three-hour continuing education course with an
increase in knowledge regarding transgender patient care and hormone therapy
for gender affirmation. As this study only evaluated the effect in short
term memory, further studies are needed to assess long term impact of the
continuing education course on transgender care knowledge.
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Affiliation(s)
| | - Edgar Carlo
- PharmD. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | | | - Jonathan Hernández-Agosto
- EdD. Associate Professor, Director of Curriculum and Institutional Effectiveness. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | - Darlene Santiago Quiñones
- PhD, MS. Associate Professor. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | | | - Carlos E Rodríguez-Díaz
- PhD, MPHE, MCHES. Associate Professor, Director Community-Oriented Primary Care Program. Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Washington, DC (United States).
| | - Kyle Melin
- PharmD, MSc, BCPS. Associate Professor. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
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Schiaffino MK, Ruiz M, Yakuta M, Contreras A, Akhavan S, Prince B, Weech-Maldonado R. Culturally and Linguistically Appropriate Hospital Services Reduce Medicare Length of Stay. Ethn Dis 2020; 30:603-610. [PMID: 32989360 DOI: 10.18865/ed.30.4.603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Almost 40% of the 63 million Americans who speak a language other than English have limited English proficiency (LEP). This communication barrier can result in poor quality care and potentially adverse health outcomes. Of particular interest is that the greatest proportion of LEP adults are aged >65 years and will face barriers and delays in accessing high-quality care. Age cohort variation of LEP burden has not been widely addressed. Culturally and linguistically appropriate hospital care delivery can mitigate these barriers. Methods In order to test whether culturally competent services reduced length-of-stay (LOS), we linked organizational cultural competence surveys across two-states (CA+FL) for comparison across Medicare acute care LOS. Using the 2013 American Hospital Association Database, and Hospital Compare Data from CMS (N=184), we compared hospital structure with culturally and linguistically appropriate services related to improved care delivery for LEP populations and aging LEP populations. We utilized Kruskal-Wallis to test group differences and a negative binomial regression to model median LOS. All analyses were conducted using SAS 9.4 (Cary, NC). Results Median LOS across all hospitals was 4.7 days (mean 5.7, standard deviation 6.3). Most hospitals were not-for-profit (46.7%), small (<150 beds, 54.4%), Joint Commission accredited (67.9%), and in urban areas. We found shorter median LOS when hospital units identified cultural or language needs at admission (Wald χ 23.82, P=.0506). Hospitals' identification of these needs at discharge had no impact on LOS. Hospitals that accommodated patient cultural or ethnic dietary needs also reported lower median LOS (Wald χ 2 12.93, P=.0003). Structurally, public hospitals, accredited hospitals, and hospitals that reported system membership were predictive of a lower median LOS. Discussion Our findings demonstrate that patient outcomes are responsive to culturally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of culturally and linguistically appropriate care for a rapidly growing population of diverse older adults.
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Affiliation(s)
| | - Melissa Ruiz
- School of Public Health, San Diego State University, San Diego, CA
| | - Melissa Yakuta
- School of Public Health, San Diego State University, San Diego, CA
| | | | - Setareh Akhavan
- School of Public Health, San Diego State University, San Diego, CA
| | - Britney Prince
- School of Public Health, San Diego State University, San Diego, CA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
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Katz C, Barnes M, Osta A, Walker-Descartes I. The Acculturation Toolkit: An Orientation for Pediatric International Medical Graduates Transitioning to the United States Medical System. MedEdPORTAL 2020; 16:10922. [PMID: 32704536 PMCID: PMC7373352 DOI: 10.15766/mep_2374-8265.10922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/26/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION International medical graduates (IMGs) consistently contribute to the US physician workforce. In fact, 25% of practicing pediatricians in the US are IMGs, highlighting the needs of IMG trainees. IMGs face unique challenges with acculturation compared to their peers due to unfamiliarity with the US medical system, especially the dynamics around patient-centered care. The literature supports the need for formal acculturation curricula. METHODS A cohort of program directors who train pediatric IMGs coupled findings from the literature with local themes from IMG focus groups to identify topics for an acculturation curriculum. Three small-group workshops utilized didactics, discussion, and role-play to cover topics related to patient-centered care, challenging communication with patients, complex psychosocial histories, and health literacy. The pilot was modified based on feedback and to enhance generalizability. The resulting four-module curriculum with presentations and supplemental materials is presented here. RESULTS After a 3-year pilot with 36 PGY 1 trainees, postcurriculum surveys reported 8.1 out of 10 in workshop satisfaction, plus increased knowledge and skills related to patient-centered care and communication with patients. Role-plays were the favorite activity. A 1-year follow-up survey reported the workshops to be influential on satisfaction with patient relationships and easing transition to residency. DISCUSSION A pilot acculturation curriculum addressing needs of pediatric IMG trainees was well received by participants and improved their comfort level in addressing challenging patient-communication scenarios. Pediatric programs that train IMGs can incorporate this curriculum to aid residents' transition to clinical practice in the US.
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Affiliation(s)
- Cynthia Katz
- Assistant Clinical Professor, Department of Pediatrics, Icahn School of Medicine at Mount Sinai; Associate Residency Program Director, Department of Pediatrics, Icahn School of Medicine at Mount Sinai
| | - Michelle Barnes
- Associate Professor, Department of Pediatrics, University of Illinois College of Medicine; Associate Residency Program Director, Department of Pediatrics, University of Illinois College of Medicine
| | - Amanda Osta
- Associate Professor, Department of Pediatrics, University of Illinois College of Medicine; Residency Program Director, Department of Pediatrics, University of Illinois College of Medicine
| | - Ingrid Walker-Descartes
- Assistant Professor, Department of Pediatrics, State University of New York Downstate Medical Center College of Medicine; Residency and Fellowship Program Director, Department of Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn
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Al-Jumaili AA, Ahmed KK, Koch D. Barriers to healthcare access for Arabic-speaking population in an English-speaking country. Pharm Pract (Granada) 2020; 18:1809. [PMID: 32477432 PMCID: PMC7243745 DOI: 10.18549/pharmpract.2020.2.1809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.
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Affiliation(s)
- Ali A Al-Jumaili
- MPH, PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Kawther K Ahmed
- PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Dave Koch
- BS. Johnson County Public Health. Iowa City, IA (United States).
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Woll A, Quick KK, Mazzei C, Selameab T, Miller JL. Working With Interpreters as a Team in Health Care (WITH Care) Curriculum Tool Kit for Oral Health Professions. MedEdPORTAL 2020; 16:10894. [PMID: 32352031 PMCID: PMC7187915 DOI: 10.15766/mep_2374-8265.10894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/25/2019] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Limited English proficiency (LEP) patients face multiple care barriers and disproportionate risks for communication errors. Working with trained interpreters as a health care team can improve communication and drive high-quality care for LEP patients. Simulation and interprofessional education provide key strategies to address the critical training gap that exists at the intersection of patient safety, interprofessional practice, and cultural competence. METHODS Using action research principles across 16 months, we created a 3.5-hour simulation-based training for oral health and interpreting learners. The curriculum included profession-specific orientations with didactic and experiential content, three immersive simulations using start-stop-rewind methodology, virtual scenarios, and summary reflection discussions. A comprehensive tool kit facilitated curriculum implementation and standardization. RESULTS Forty-nine students from dentistry (first- through third-year predoctoral), dental hygiene, and dental therapy participated in this elective training during the 2017-2018 academic year; as required training, 126 third-year dental students participated in fall 2018. Students' familiarity with provider and interpreter best practices, appreciation of challenges faced by LEP patients, and confidence in skills working with spoken language interpreters increased. For all evaluation parameters, pre- and postsurvey ratings were statistically significant (chi-square tests, p < .001). DISCUSSION The curriculum efficiently and effectively develops oral health and interpreting learners' abilities to work as a team with LEP patients. Curriculum design and resources address key barriers to feasibility and sustainability. The curriculum informs communication across all patient populations, revealing that getting by with partial understanding can be insufficient for any patient and any health care team.
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Affiliation(s)
- Anne Woll
- Associate Director, Interprofessional Education and Resource Center, University of Minnesota
- Associate Director, Academic Health Center Simulation Center, University of Minnesota
| | - Karin K. Quick
- Associate Professor, Department of Primary Dental Care, University of Minnesota School of Dentistry
- Director, Division of Dental Public Health, Department of Primary Dental Care, University of Minnesota School of Dentistry
- Director, Global Programs, Department of Primary Dental Care, University of Minnesota School of Dentistry
| | - Cristiano Mazzei
- Director, Translator and Interpreter Training, Department of Languages, Literatures, and Cultures, University of Massachusetts Amherst
| | | | - Jane L. Miller
- Clinical Associate Professor, Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine
- Director, Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine
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Neff J, Holmes SM, Knight KR, Strong S, Thompson-Lastad A, McGuinness C, Duncan L, Saxena N, Harvey MJ, Langford A, Carey-Simms KL, Minahan S, Satterwhite S, Ruppel C, Lee S, Walkover L, De Avila J, Lewis B, Matthews J, Nelson N. Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities. MedEdPORTAL 2020; 16:10888. [PMID: 32342010 PMCID: PMC7182045 DOI: 10.15766/mep_2374-8265.10888] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/18/2019] [Indexed: 05/08/2023]
Abstract
Introduction Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. Methods We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Results Three core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions. Discussion This structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health.
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Affiliation(s)
- Joshua Neff
- Resident, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Seth M. Holmes
- Associate Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management, University of California, Berkeley
- Associate Professor, Joint Program in Medical Anthropology, University of California, Berkeley
| | - Kelly R. Knight
- Associate Professor, Department of Anthropology, History and Social Medicine, University of California, San Francisco
| | | | - Ariana Thompson-Lastad
- Postdoctoral Fellow, Osher Center for Integrative Medicine, University of California, San Francisco
| | - Cara McGuinness
- Nurse Midwife, Boston Medical Center
- Clinical Instructor, Department of Obstetrics & Gynecology, Boston University School of Medicine
| | - Laura Duncan
- MD/PhD Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco
| | - Nimish Saxena
- Undergraduate Student, University of California, Berkeley
| | - Michael J. Harvey
- Assistant Professor, Department of Health Science and Recreation, San José State University
| | - Alice Langford
- Undergraduate Student, University of California, Berkeley
| | | | | | - Shannon Satterwhite
- Medical Student in the Medical Scientist Training Program, Department of Anthropology, History and Social Medicine, University of California, San Francisco
| | - Caitlin Ruppel
- Health Policy and Management MPH Student, School of Public Health, University of California, Berkeley
| | - Sonia Lee
- Senior Manager, Health Outreach Partners
| | - Lillian Walkover
- Postdoctoral Fellow in Global Health, Department of Sociology, Drexel University
| | - Jorge De Avila
- Medical Student, University of Chicago Pritzker School of Medicine
| | - Brett Lewis
- Medical Student, Oregon Health & Science University School of Medicine
| | - Jenifer Matthews
- Core Faculty, Department of Adolescent Medicine, UCSF Benioff Children's Hospital Oakland
| | - Nicholas Nelson
- Associate Program Director, Internal Medicine Residency Program, Highland Hospital, Oakland, California
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Radix AE. Addressing Needs of Transgender Patients: The Role of Family Physicians. J Am Board Fam Med 2020; 33:314-21. [PMID: 32179615 DOI: 10.3122/jabfm.2020.02.180228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/08/2022] Open
Abstract
There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre- and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.
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Tolliver SO, Hefner JL, Tolliver SD, McDougle L. Primary Care Provider Understanding of Hair Care Maintenance as a Barrier to Physical Activity in African American Women. J Am Board Fam Med 2019; 32:944-7. [PMID: 31704765 DOI: 10.3122/jabfm.2019.06.190168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION African American (AA) women have reported hair maintenance as a barrier to regular exercise; however, to our knowledge, this study is the first to identify primary care provider thoughts, attitudes, beliefs, and knowledge regarding hair as a barrier to increased physical activity among AA females. METHODS A 13-question electronic survey was sent via email to 151 clinicians working within a department of family medicine's 8 ambulatory clinics within a large urban academic medical center. RESULTS A total of 62 primary care clinicians completed the survey, which is a response rate of 41%. The vast majority of respondents (95%) sometimes/often engage in discussions with AA female patients regarding physical activity. However, 76% of respondents have never included a hairstyling or maintenance assessment in that discussion and only 34% noted being comfortable discussing this topic. Among a list of potential barriers to exercise, hair maintenance/scalp perspiration was rarely endorsed as important by clinicians. DISCUSSION This study highlights a need for increased education among primary care providers regarding AA hair care and maintenance practices as a barrier to increased physical activity in AA women. If specific barriers to increasing healthy habits among AA women are to be addressed, there must be a baseline knowledge of hair care and maintenance barriers, an understanding of the strong influence of cultural norms and practices as it relates to physical activity and exercise, and an increased comfortability when engaging in difficult cross-cultural conversations to ultimately improve health outcomes in AA females.
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Abstract
Introduction: Cultural sensitivity training among pharmacy students is required by the Accreditation Council for Pharmacy Education, but little data exists on effective practices for teaching these concepts. The goal of this case study was to describe the process and determine if integration of a patient-led Cultural Sensitivity Panel into the required didactic curriculum impacts pharmacy student perceptions of their own cultural competence. Description of case: A special population was defined based on the CAPE competencies requiring students demonstrate sensitivity and responsiveness to culture, race/ethnicity, socioeconomic status, gender, sexual orientation, spirituality, disability, and other aspects of diversity and identity. Patients representing various special populations, such as veterans, the Deaf and hard of hearing population, the LGBT community, were invited to participate in a Cultural Sensitivity Panel for two consecutive years. Panelists shared information they wish future healthcare professionals understood about the population they represented and participated in a question and answer session. Pre- and post-surveys were conducted to assess the impact of the panel on student perceptions of cultural competence. Results: Over two years, 138 students completed surveys. More than 95% of students agreed or strongly agreed that a cultural sensitivity panel is a worthwhile experience, and that the panel would help them change behaviors that may be culturally insensitive. Student perceptions of their own cultural competence significantly improved between the pre- and post- surveys; ethnicity, age and gender significantly impacted responses (p<.05). Key themes of responses to open-ended questions included learning about effective communication (64%), new resources for diverse patient populations (28%), addressing barriers to care (21%), the importance of patience and empathy (18%), and incorporating a patient’s background into their care (18%). Exploration of case impact: Use of a cultural sensitivity panel provides patients with their own voice in discussing barriers to the provision of health care and thus mitigates the inherent bias and limitations of faculty members teaching about cultures and populations they do not represent. Conclusion: This novel approach of integrating a Cultural Sensitivity Panel into the didactic curriculum positively impacted student perceptions of their own cultural competence and may improve culturally competent provision of care among pharmacy students.
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Affiliation(s)
| | - Annesha White
- University of North Texas System College of Pharmacy
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West TJ, Loomer K, Wyatt TR. How Diverse Is Your Universe? An Activity for Students to Reflect on Ethnoracial Diversity During Orientation. MedEdPORTAL 2019; 15:10840. [PMID: 31890871 PMCID: PMC6897539 DOI: 10.15766/mep_2374-8265.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Physicians' unconscious biases have been linked to health disparities within ethnic and racially diverse communities. Addressing these unconscious biases is difficult but may be ameliorated by raising individuals' awareness of the ethnoracial makeup of their personal and professional networks and reflecting on whether it needs to be expanded while in medical school. METHODS First- and second-year students were provided with an overview of the ethnoracial makeup of individuals within the state, community, and medical school as a means to reflect on the ethnoracial makeup of their future patient population. Following this overview, students engaged in an activity adapted from the University of Houston, which allowed them to visually represent the ethnoracial diversity within their networks. Written reflections on the adapted activity were collected, analyzed using manifest content analysis, and reported according to themes. RESULTS The results indicated that the activity was valuable in helping students visualize their current exposure to ethnoracially diverse individuals (143 of 357 responses [40%]) and reflect on their need to expand the level of ethnoracial diversity in their lives (47 of 357 responses [13%]). Additionally, students provided comments to help improve the activity when used in another institution. DISCUSSION Assisting students in raising their awareness of the ethnoracial diversity in their personal and professional networks is a step toward addressing the unconscious biases that emerge in physicians while in clinical practice. This activity, designed to raise students' awareness of ethnoracial diversity, originated in Augusta, Georgia, but can be adapted to any state.
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Affiliation(s)
- Tahira J. West
- Fourth-Year Medical Student, Medical College of Georgia at Augusta University
| | - Kimberly Loomer
- Associate Dean of Multicultural and Student Affairs, Medical College of Georgia at Augusta University; Associate Professor of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University
| | - Tasha R. Wyatt
- Educational Researcher/Associate Professor, Educational Innovation Institute, Medical College of Georgia at Augusta University
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McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers. Ethn Dis 2019; 29:359-364. [PMID: 31308606 DOI: 10.18865/ed.29.s2.359] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations.
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Neto A, Costa AG, Machado AG, Conceição D, Coutinho C, Rousseau C. Refugee Resettlement I: Challenges for Mental Healthcare Services in Portugal. ACTA MEDICA PORT 2019; 32:14-16. [PMID: 30753798 DOI: 10.20344/amp.10206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Ana Neto
- Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
| | - Ana Gomes Costa
- Unidade de Saúde Familiar AlphaMouro. Agrupamento de Centros de Saúde de Sintra. Sintra. Portugal
| | - Ana Gomes Machado
- Unidade de Saúde Familiar Monte da Luz. Agrupamento de Centros de Saúde de Sintra. Sintra. Portugal
| | - Dora Conceição
- Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
| | - Carla Coutinho
- Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
| | - Cecile Rousseau
- Transcultural Research and Intervention Team (TRIT). Division of Social and Transcultural Psychiatry. McGill University. Montreal. Canadá
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Kreif TM, Yoshimoto SK, Mokuau N. Insights in Public Health: Ke A'o Mau: Strengthening Cultural Competency in Interdisciplinary Education. Hawaii J Med Public Health 2018; 77:333-336. [PMID: 30533287 PMCID: PMC6277837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In order to successfully address social determinants of health and to achieve social justice for kanaka and all the people of Hawai'i, we must broaden our understanding of and approach to healing/health through interdisciplinary, culturally-informed education. Strengthening cultural competence within an Interprofessional Education framework, has potential in meeting important challenges in patient and population health, including meeting the increased demand for culturally trained professionals, increasing access to providers, and reducing health inequities in kanaka (Native Hawaiians). We present a model of course design and delivery, Ke A'o Mau (Learning Preserved), intended to provide haumana (students) with a unique body of culturally-anchored and community-based knowledge, skills and values that facilitate work with kanaka. Ke A'o Mau was implemented in the 2017-2018 academic year at University of Hawai'i (UH) at Manoa and optimized the authenticity of cultural learning through the engagement of kumu loea (expert teachers) to instruct in their area of expertise. Design and delivery of the course began with the understanding and honoring of kanaka worldviews, knowledge, and practices. Appraisal of haumana learning showed strong evaluative scores, of knowledge development, skills training, and instructional materials. This course not only seeks to resolve critical challenges in patient and population health but also provides a model to support the UH Manoa strategic priority of "striving to be a foremost indigenous-serving institution."
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Affiliation(s)
- Theresa M Kreif
- Myron B. Thompson School of Social Work, University of Hawai'i at Manoa, Honolulu, HI
| | | | - Noreen Mokuau
- Myron B. Thompson School of Social Work, University of Hawai'i at Manoa, Honolulu, HI
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Song AY, Poythress EL, Bocchini CE, Kass JS. Reorienting Orientation: Introducing the Social Determinants of Health to First-Year Medical Students. MedEdPORTAL 2018; 14:10752. [PMID: 30800952 PMCID: PMC6342337 DOI: 10.15766/mep_2374-8265.10752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/14/2018] [Indexed: 05/25/2023]
Abstract
Introduction Medical students rarely learn about the intersection of socioeconomic and environmental effects on access to health care and maintenance of health. Case-based discussion can cohesively highlight the social determinants of health to complement preclinical education. Our modules can foster future interest in working with vulnerable populations, help students recognize barriers to care, and identify strategies to help these patients. Methods The Social Determinants of Health Orientation Program (SDHOP) introduced students to the nonbiomedical factors that contribute to patients' health. Key topics were presented in small discussion groups led by faculty facilitators. The subjects addressed included access to care; immigration/language barriers; lesbian, gay, bisexual, and transgender health; human trafficking; race/ethnicity; and women's health. Results The SDHOP initiative was integrated into the formal curriculum and successfully implemented in its first year at our institution. Pre- and postsurveys were administered to assess student satisfaction with the course, as well as changes in knowledge and attitude regarding the topics covered. Of the 186 SDHOP participants, 111 medical students responded to both surveys and reported improvements in both knowledge of and comfort level with these topics and specific related terms. Ninety-one percent rated the overall quality of SDHOP and its individual modules as good or excellent. Discussion SDHOP contributes to medical education by providing an all-inclusive model for teaching students about the social determinants of health. Our results suggest that presenting these topics in a small-group discussion model improves medical student cultural competency and comfort level with patients of diverse backgrounds.
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Affiliation(s)
| | - Edward Lee Poythress
- Assistant Dean, Office of Student Affairs, Baylor College of Medicine
- Associate Professor, Department of Internal Medicine, Baylor College of Medicine
| | - Claire E. Bocchini
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine
| | - Joseph S. Kass
- Associate Dean, Office of Student Affairs, Baylor College of Medicine
- Professor, Department of Neurology, Baylor College of Medicine
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Abstract
INTRODUCTION Effective mentoring can contribute to wellness and career growth and satisfaction. However, the same social forces and interpersonal dynamics affecting all relationships can compromise mentoring relationships. This is especially true when there are issues that are compounded by structural disadvantage due to racism, gender bias, social class, and other discriminatory factors. The Mentoring Across Differences (MAD) sessions are a workshop designed to develop and nurture skills, tools, self-awareness, and mindful practice in mentors and mentees. The workshop encourages participants to gain confidence in navigating differences across a variety of domains. METHODS We designed interactive sessions for faculty as part of a nine-part training series on mentoring in an academic setting. Teaching methods drew from adult learning theory. We used cases distilled from real teaching and mentoring experiences to trigger discussion and activate emotion and intrinsic motivation. Participants' prior knowledge and experience were drawn on to cocreate knowledge through small-group peer learning. RESULTS As part of a course, 167 participants completed the sessions; several hundred more people participated in them in faculty development venues. Participants highly rated the open discussions regarding differences and enhanced awareness of their assumptions, specifically highlighting knowledge and tools addressing bias in their roles as mentors and teachers. DISCUSSION The MAD sessions function both as an important module in a comprehensive mentoring curriculum and as stand-alone sessions. They fill a critical need of faculty and training institutions to explore difference in order to foster diversity and inclusion.
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Affiliation(s)
- Nora Yusuf Osman
- Assistant Professor of Medicine, Harvard Medical School
- Medicine Clerkship Director, Brigham and Women's Hospital
| | - Barbara Gottlieb
- Associate Professor of Medicine, Harvard Medical School
- Associate Program Director, Medicine Residency Program, Brigham and Women's Hospital
- Corresponding author:
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Endrizal CL, Fialkowski MK, Davis J, Yuan S, Novotny R, Delormier TWI, Rodriguez B. Dietetics Practice in the Unique, Culturally Diverse Pacific Island Region. Hawaii J Med Public Health 2018; 77:135-143. [PMID: 29888116 PMCID: PMC5993991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Pacific Island region is geographically the most isolated region in the world representing a diverse population of indigenous peoples, migrated groups and new-comers. Rates of chronic disease are predominately high in populations identified as Pacific Islander. The practice of dietetics, defined as nutrition education for the prevention of disease and medical nutrition therapy for the treatment of chronic diseases, proves challenging with the unique cultural diversity in the region. There is a need to describe dietetics practice, populations served, and needs for resources identified by nutrition-related topic and cultural relevance for Registered Dietitian Nutritionists in the Pacific Island region. An online survey was distributed to all members of the Hawai'i Affiliate of the Academy of Nutrition and Dietetics in 2013-2014. The online survey yielded 104 usable responses. Most participants were female and lived and worked in the Hawaiian Island region. One-third of practicing Registered Dietitian Nutritionists saw >100 patients or clients per month. Most prevalent populations served were identified as Asian and Pacific Islanders. Culturally relevant resources of the highest need were relevant to Asian and Pacific Islander cultures, specifically addressing weight control and diabetes. Dietetics practice in the Pacific Island region is unique given the prevalence of Asians and Pacific Islanders served by Registered Dietitian Nutritionists. Findings will inform the development of new, culturally appropriate online nutrition resources, to enhance dietetics practice in the region. Making these resources available online will be useful for Registered Dietitian Nutritionists and other health care practitioners working in the Pacific Island region.
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Affiliation(s)
- Cynthia L Endrizal
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Marie Kainoa Fialkowski
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Jim Davis
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Sarah Yuan
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Rachel Novotny
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Treena Wasonti Io Delormier
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
| | - Beatriz Rodriguez
- Biomedical Sciences, Clinical Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (CLE)
- Human Nutrition, Food and Animal Sciences, University of Hawai'i at Manoa, Honolulu, HI (MKF, RN)
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JD)
- Center on the Family, University of Hawai'i at Manoa, Honolulu, HI (SY)
- Indigenous Peoples' Nutrition and Food Security, Center for Indigenous Peoples' Nutrition and Environment, Macdonald Campus, McGill University, Quebec, Canada (TWD)
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (BR)
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Satpute KH, Hall T, Adanani A. Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction. J Manipulative Physiol Ther 2018; 41:242-251. [PMID: 29482874 DOI: 10.1016/j.jmpt.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/31/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. METHODS This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. RESULTS Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. CONCLUSION These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.
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Affiliation(s)
- Kiran H Satpute
- Department of Kinesiotherapy and Physical Diagnosis, Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashatra, India.
| | - Toby Hall
- School of Physiotherapy and Curtin Health Innovation Research, Curtin University, Perth, Australia
| | - Aditi Adanani
- Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashatra, India
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Fitzgerald SN, Leslie KF, Simpson R, Jones VF, Barnes ET. Culturally Effective Care for Refugee Populations: Interprofessional, Interactive Case Studies. MedEdPORTAL 2018; 14:10668. [PMID: 30800868 PMCID: PMC6342357 DOI: 10.15766/mep_2374-8265.10668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/24/2017] [Indexed: 05/14/2023]
Abstract
Introduction Within health sciences education literature, the majority of reported student experiences with refugee populations are limited to traditional, professionally independent, elective courses and extracurricular volunteer opportunities. A simulated patient exercise is a learning opportunity that helps participants engage with material in real time in a realistic environment, demanding higher levels of learning. This session utilized a simulated patient facilitator in interprofessional small groups to explore common health needs and barriers to care among refugee populations. Methods Health professions students from nine degree programs participated in a refugee health session in interprofessional teams of nine to 10 students to explore patient cases. The session concluded with a debriefing discussing the outcomes of the student-patient interaction, best practices, and exemplary practice models as takeaways. The simulated patient facilitators completed an Observation Checklist to assess students' grasp of learning objectives. Results Five hundred twenty-four students participated in the refugee session, divided into 61 groups. Observation Checklists were completed for 58 groups (95%). Assessment of student engagement focused on general health needs common to refugee populations: barriers to health care, team and individual roles, bias, consequences of nontreatment, and social determinants of health. Most of the groups (95%) reported engagement between the simulated patient facilitator and the group of student providers. Qualitative data indicated student groups were knowledgeable in each of the overarching learning objectives. Discussion This session allowed health sciences students to focus on culturally effective patient care for refugee populations as a part of an interprofessional team.
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Affiliation(s)
- Shannon N. Fitzgerald
- Coordinator, Department of Dental Clinical Affairs, University of Louisville School of Dentistry
| | - Katie F. Leslie
- Program Manager, Office of Diversity and Inclusion, University of Louisville Health Sciences Center
| | - Ryan Simpson
- Assistant Director, Office of Diversity and Inclusion, University of Louisville Health Sciences Center
| | - V. Faye Jones
- Associate Vice President, Health Affairs/Diversity Initiatives, University of Louisville Health Sciences Center
- Professor, Department of Pediatrics, University of Louisville School of Medicine
| | - Elizabeth Tatum Barnes
- Research Associate for the Refugee Health Initiative, Department of Medicine, Division of Infectious Disease, University of Louisville School of Medicine
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Maiers MJ, Foshee WK, Henson Dunlap H. Culturally Sensitive Chiropractic Care of the Transgender Community: A Narrative Review of the Literature. J Chiropr Humanit 2017; 24:24-30. [PMID: 29463964 PMCID: PMC5812907 DOI: 10.1016/j.echu.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/07/2017] [Accepted: 05/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Transgender individuals commonly experience barriers to quality health care and may suffer from unique musculoskeletal complaints. Although these needs are often inadequately addressed within the health care system, they could be attended to by the chiropractic community. This narrative review describes best practices for delivering culturally sensitive care to transgender patients within the context of chiropractic offices. METHODS A literature search generated peer-reviewed material on culturally competent care of the transgender community. Google Scholar and trans-health RSS feeds on social media were also searched to find relevant gray literature. Information pertinent to a chiropractic practice was identified and summarized. RESULTS Contemporary definitions of transgender, gender identity, and sexual orientation provide a framework for culturally sensitive language and clinic culture. Small changes in record keeping and office procedures can contribute to a more inclusive environment for transgender patients and improve a chiropractor's ability to collect important health history information. Special considerations during a musculoskeletal examination may be necessary to properly account for medical and nonmedical practices transgender patients may use to express their gender. Chiropractors should be aware of health care and social and advocacy resources for transgender individuals and recommend them to patients who may need additional support. CONCLUSIONS Small yet intentional modifications within the health care encounter can enable chiropractors to improve the health and well-being of transgender individuals and communities.
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Affiliation(s)
- Michele J. Maiers
- Center for Healthcare Innovation and Policy, Northwestern Health Sciences University, Bloomington, Minnesota
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Bakhai N, Ramos J, Gorfinkle N, Shields R, Fields E, Frosch E, Shochet R, Sanders R. Introductory Learning of Inclusive Sexual History Taking: An E-Lecture, Standardized Patient Case, and Facilitated Debrief. MedEdPORTAL 2016; 12:10520. [PMID: 30984862 PMCID: PMC6440490 DOI: 10.15766/mep_2374-8265.10520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION This student-driven curriculum intervention, implemented with first-year medical students, was guided by the Association of American Medical Colleges' standards for medical education on health care for sexual and gender minorities. Its goals are to describe the spectrum of sexual orientation and gender identity and sensitively and effectively elicit relevant information from patients about their sexual orientation and gender identity through inclusive sexual history taking. METHODS Developed through student-faculty collaboration, this three-part module includes a 14-minute e-lecture on taking an inclusive sexual history, a 35-minute formative standardized patient encounter in which students take a sexual history and receive feedback, and a 20-minute facilitated group debrief on the standardized patient activity. RESULTS Students completed a postmodule evaluation anonymously; the majority of respondents (92%) agreed that they felt more prepared to take a sexual history inclusive of sexual and gender minority patients. Most were more comfortable discussing sexual orientation (91%) and gender identity (83%) with patients after the module. Content analysis revealed an improved confidence in creating a safe space for sexual and gender minority patients and an increased awareness of biases about sexual and gender minority patients. DISCUSSION This curriculum serves as an early foundation for students to understand sexual and gender minority identities and develop confidence in their inclusive sexual history taking skills before they provide care for patients. In addition, the student-driven curriculum development process used can serve as a template for students at other institutions hoping to collaborate with faculty to develop comprehensive sexual and gender minority curricula.
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Affiliation(s)
- Neha Bakhai
- Third-year Medical Student, Johns Hopkins University School of Medicine
- Corresponding author:
| | - Julia Ramos
- Third-year Medical Student, Johns Hopkins University School of Medicine
| | - Naomi Gorfinkle
- Third-year Medical Student, Johns Hopkins University School of Medicine
| | | | - Errol Fields
- Assistant Professor, Department of Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine
| | - Emily Frosch
- Associate Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Robert Shochet
- Associate Professor of Medicine, Johns Hopkins University School of Medicine
| | - Renata Sanders
- Assistant Professor, Department of Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine
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Brown EA, Bekker HL, Davison SN, Koffman J, Schell JO. Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making. Clin J Am Soc Nephrol 2016; 11:1902-1908. [PMID: 27510456 PMCID: PMC5053803 DOI: 10.2215/cjn.13661215] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs.
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Affiliation(s)
- Edwina A. Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sara N. Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, United Kingdom; and
| | - Jane O. Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bakhai N, Shields R, Barone M, Sanders R, Fields E. An Active Learning Module Teaching Advanced Communication Skills to Care for Sexual Minority Youth in Clinical Medical Education. MedEdPORTAL 2016; 12:10449. [PMID: 31008227 PMCID: PMC6464565 DOI: 10.15766/mep_2374-8265.10449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Expert recommendations state that all physicians caring for youth should be trained in providing competent and nonjudgmental care for sexual and gender minority (SGM) youth. Despite those recommendations, there is insufficient training to prepare clinicians to provide culturally competent care for SGM youth. We created a 2-hour session to address communication skills critical to caring for SGM youth. The goals of the session were for third- and fourth-year medical learners to affirm, validate, and assess the mental health status of their patient, collaborate with a school counselor, support families in acceptance of SGM children, and provide them with relevant resources. METHODS The session utilized multiple active learning modalities including flipped classroom, small-group learning, and peer-to-peer instruction. Learners completed anonymous pre- and postsurveys that aimed to measure their comfort, self-efficacy, and self-reported preparedness in counseling adolescents questioning their sexual orientation. RESULTS Of the 42 learners who participated in the course over two academic terms, 40 (95%) completed the presurvey, and 39 (93%) completed the postsurvey. Learners demonstrated a significant improvement in self-reported knowledge, comfort, and sense of preparedness on all skill-based objectives and reported growth in their comfort and sense of preparedness for counseling adolescents questioning their sexual orientation after participating in the session (p < .001). DISCUSSION This session supports the development of key communication skills needed to provide competent and nonjudgmental care for SGM youth. It can be easily replicated at other health professional schools looking to improve the cultural competency of future clinicians around care for SGM patients.
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Affiliation(s)
- Neha Bakhai
- Second-year Medical Student, Johns Hopkins University School of Medicine
- Corresponding author:
| | - Ryan Shields
- Fourth-year Medical Student, Johns Hopkins University School of Medicine
| | - Michael Barone
- Associate Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Renata Sanders
- Assistant Professor, Department of Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine
| | - Errol Fields
- Assistant Professor, Department of Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine
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Rogers JM, Morris MA, Hook CC, Havyer RD. Introduction to Disability and Health for Preclinical Medical Students: Didactic and Disability Panel Discussion. MedEdPORTAL 2016; 12:10429. [PMID: 31008209 PMCID: PMC6464457 DOI: 10.15766/mep_2374-8265.10429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Millions of American patients have a disability, and their health care outcomes depend on the attitudes of their health care providers towards persons with disabilities. Overly negative health care provider attitudes lead to significant misunderstandings about what it means to have a disability, inappropriate assumptions, and poor care. However, very few medical schools teach about disability. METHODS We developed a preclinical medical student curriculum that addresses the complexity of disability, focusing on health care disparities and bias. Our curriculum was designed with significant input from people with disabilities and was constructed from their perspective. In addition to didactic and discussion sessions on disability history, models of disability, and health disparities, we include a discussion panel with community members who have a disability. RESULTS The curriculum has been effective at promoting discussion and is well received by students. When rating the relevance to future clinical practice, students gave the curriculum an average of 3.9 on a 5-point Likert scale (1 = poor, 5 = excellent). The majority of students commented that the community involvement in the session was the most meaningful aspect. DISCUSSION It is possible to integrate community-driven discussions on the social context of disability into traditional medical school preclinical curricula, and students find it valuable to their education.
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Affiliation(s)
- Julie M Rogers
- Resident Physician, Department of Internal Medicine, Mayo Clinic
| | - Megan A Morris
- Director of Qualitative Research, Center for Surgery and Public Health, Brigham and Women's Hospital
| | - C Christopher Hook
- Associate Professor of Medicine, Division of Hematology and Internal Medicine, Mayo Clinic
| | - Rachel D Havyer
- Associate Professor of Medicine, Division of Internal Medicine, Mayo Clinic
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Livaudais-Toman J, Burke NJ, Napoles A, Kaplan CP. Health Literate Organizations: Are Clinical Trial Sites Equipped to Recruit Minority and Limited Health Literacy Patients? J Health Dispar Res Pract 2014; 7:1-13. [PMID: 26295011 PMCID: PMC4540367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors. METHODS We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the National Cancer Institute Physician Data Query system. From October 2008 to November 2009, we contacted one research team member (RTM) from each site for a telephone survey to assess the site's health literate characteristics. RESULTS Of 233 RTMs who responded, 93% were female and 89% were US-born. Overall, 48% of sites offered supplementary trial information, 80% offered materials to assist with patient navigation and 45% reported outreach efforts. Lower percentages offered information in other languages while 65% offered professional interpretation services. Sites with >10% limited English proficiency (LEP) patients were more likely than their counterparts to offer consent forms (OR=3.13, 1.36-7.19) and supplementary information about trials in other languages (OR=2.52, 1.15-5.52). Sites with diverse patient populations (>10% Latino) were also more likely than less diverse sites to engage in outreach (OR=1.97, 1.07-3.60), to offer consent forms (OR=2.72, 1.38-5.36), supplementary information about trials (OR=2.58, 1.24-5.36), and materials to improve patient navigation (OR=2.50, 1.22-5.13) in other languages. CONCLUSIONS Efforts to recruit diverse participants were limited. Practice type and diversity of patient population were associated with sites' efforts to accommodate these characteristics, suggesting that sites were responsive to the needs of their patients when diversity was prevalent.
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Abstract
As the diversity of the United States (US) population continues to change, concerns about minority health and health disparities grow. Health professions must evolve to meet the needs of the population. The purpose of this editorial is to review current trends in the diversity of chiropractic students, faculty, and practitioners in the United States. This editorial was informed by a search of the literature, to include PubMed, using the terms chiropractic and diversity, minority, and cultural competency. Demographic information for the chiropractic profession was obtained from the National Board of Chiropractic Examiners and The Chronicle of Higher Education. These data were compared to diversity data for medical doctors and the national and state populations from the American Association of Medical Colleges and the US Census, respectively. Surprisingly little has been published in the peer-reviewed literature on the topic of diversity in the chiropractic profession. For the variables available (sex and race), the data show that proportions in the US chiropractic profession do not match the population. State comparisons to associated chiropractic colleges show similar relationships. No reliable data were found on other diversity characteristics, such as gender identity, religion, and socioeconomic status. The chiropractic profession in the United States currently does not represent the national population with regard to sex and race. Leaders in the profession should develop a strategy to better meet the changing demographics of the US population. More attention to recruiting and retaining students, such as underrepresented minorities and women, and establishing improved cultural competency is needed.
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