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Baugh AD, Vanderbilt AA, Baugh RF. Communication training is inadequate: the role of deception, non-verbal communication, and cultural proficiency. Med Educ Online 2020; 25:1820228. [PMID: 32938330 PMCID: PMC7534221 DOI: 10.1080/10872981.2020.1820228] [Citation(s) in RCA: 4] [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: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 05/29/2023]
Abstract
In this commentary, we argue that the limited experiential exposure of medical students to different cultures makes the instruction devoted to communication skills inadequate. The relationship of these dynamics to honesty in clinical encounters is explored. Absent significant experiential exposure to differing group cultures to counter the natural tendency to favor one's own, discrimination prevails. Knowledge or awareness of cultural differences does not necessarily equate to communication proficiency. Critically, interactions based on lived experience offer a deeper knowledge and understanding of culturally meaningful nuances than that imparted through other formats. Medical students' lack of experiential exposure to different cultures results in communication miscues. When the stakes are high, people detect those miscues diminishing trust in the doctor-patient relationship. Greater experiential cultural exposure will enhance the facility and use of culturally specific communication cues. At its core, the requisite transformation will require medical students to adapt to other cultures and greater representation by marginalized and stigmatized populations not only among the studentry but staff and faculty. The time is now to ensure that the physicians we produce can care for all Americans. What cannot be taught must be identified by the selection process. Competence with half the population is a failure for American medicine.
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Affiliation(s)
- Aaron D. Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Internal Medicine, University of California San Francisco Medical School, San Francisco, CA, USA
| | | | - Reginald F. Baugh
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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2
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Baugh AD, Vanderbilt AA, Baugh RF. The Dynamics Of Poverty, Educational Attainment, And The Children Of The Disadvantaged Entering Medical School [Response To Letter]. Adv Med Educ Pract 2019; 10:867-868. [PMID: 31686945 PMCID: PMC6800554 DOI: 10.2147/amep.s231197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Aaron D Baugh
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Reginald F Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Baugh AD, Vanderbilt AA, Baugh RF. The dynamics of poverty, educational attainment, and the children of the disadvantaged entering medical school. Adv Med Educ Pract 2019; 10:667-676. [PMID: 31686941 PMCID: PMC6708885 DOI: 10.2147/amep.s196840] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/06/2019] [Indexed: 05/27/2023]
Abstract
Approximately one-third of the US population lives at or near the poverty line; however, this group makes up less than 7% of the incoming medical students. In the United Kingdom, the ratio of those of the highest social stratum is 30 times greater than those of the lowest to receive admission to medical school. In an effort to address health disparities and improve patient care, the authors argue that significant barriers must be overcome for the children of the disadvantaged to gain admission to medical school. Poverty is intergenerational and multidimensional. Familial wealth affects opportunities and educational attainment, starting when children are young and compounding as they get older. In addition, structural and other barriers exist to these students pursuing higher education, such as the realities of financial aid and the shadow of debt. Yet the medical education community can take steps to better support the children of the disadvantaged throughout their education, so they are able to reach medical school. If educators value the viewpoints and life experiences of diverse students enriching the learning environment, they must acknowledge the unique contributions that the children of the disadvantaged bring and work to increase their representation in medical schools and the physician workforce. We describe who the disadvantaged are contrasted with the metrics used by medical school admissions to identify them. The consequences of multiple facets of poverty on educational attainment are explored, including its interaction with other social identities, inter-generational impacts, and the importance of wealth versus annual income. Structural barriers to admission are reviewed. Given the multi-dimensional and cumulative nature of poverty, we conclude that absent significant and sustained intervention, medical school applicants from disadvantaged backgrounds will remain few and workforce issues affecting the care patients receive will not be resolved. The role of physicians and medical schools and advocating for necessary societal changes to alleviate this dynamic are highlighted.
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Affiliation(s)
- Aaron D Baugh
- Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Reginald F Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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4
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Lambert JA, Vanderbilt AA, Papadimos TJ. Improved emotional intelligence in perioperative care through simulation-based medical education during anesthesiology residency training: a call for implementation. Adv Med Educ Pract 2019; 10:39-42. [PMID: 30774498 PMCID: PMC6361314 DOI: 10.2147/amep.s164752] [Citation(s) in RCA: 5] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emotional intelligence (EI) is the processing of emotional information. It reflects the ability to 1) monitor one's own and others' emotions, 2) discriminate among them, 3) and use this information to guide one's thinking and actions. Higher EI contributes to the doctor-patient relationship, increased empathy, stress management, and leadership. Although EI has been shown to be beneficial in a hospital setting, little work has been done specifically on EI and its efficacy in the perioperative period. There are instances during perioperative care where rise and conflict occur, an environment where EI skills can play an important role. Instituting simulation-based training programs that cover critical skills related to EI early in anesthesiology residency may facilitate constructive interactions with interdisciplinary teams, leading to improved outcomes for patients during perioperative care. These programs in EI would also incorporate elements of the Accreditation Council for Graduate Medical Education (ACGME) core competencies, only adding to the benefit for these residents.
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Affiliation(s)
- Juli A Lambert
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA,
| | - Allison A Vanderbilt
- Curriculum Evaluation and Innovation, Family Medicine College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Thomas J Papadimos
- Lloyd Jacobs Simulation Center, Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA
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Ratycz MC, Papadimos TJ, Vanderbilt AA. Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. Med Educ Online 2018; 23:1466574. [PMID: 29708863 PMCID: PMC5933286 DOI: 10.1080/10872981.2018.1466574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/01/2017] [Accepted: 04/10/2018] [Indexed: 05/25/2023]
Abstract
Substance abuse is a growing public health concern in the USA (US), especially now that the US faces a national drug overdose epidemic. Over the past decade, the number of drug overdose deaths has rapidly grown, largely driven by increases in prescription opioid-related overdoses. In recent years, increased heroin and illicitly manufactured fentanyl overdoses have substantially contributed to the rise of overdose deaths. Given the role of physicians in interacting with patients who are at risk for or currently abusing opioids and heroin, it is essential that physicians are aware of this issue and know how to respond. Unfortunately, medical school curricula do not devote substantial time to addiction education and many physicians lack knowledge regarding assessment and management of opioid addiction. While some schools have modified curricula to include content related to opioid prescription techniques and pain management, an added emphasis about the growing role of heroin and fentanyl is needed to adequately address the epidemic. By adapting curricula to address the rising opioid and heroin epidemic, medical schools have the potential to ensure that our future physicians can effectively recognize the signs, symptoms, and risks of opioid/heroin abuse and improve patient outcomes. This article proposes ways to include heroin and fentanyl education into medical school curricula and highlights the potential of simulation-based medical education to enable students to develop the skillset and emotional intelligence necessary to work with patients struggling with opioid and heroin addiction. This will result in future doctors who are better prepared to both prevent and recognize opioid and heroin addiction in patients, an important step in helping reduce the number of addicted patients and address the drug overdose epidemic.
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Affiliation(s)
- Madison C. Ratycz
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Thomas J. Papadimos
- Simulation Center Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA
| | - Allison A. Vanderbilt
- Curriculum Evaluation and Innovation, Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Anderson PM, Vanderbilt AA. Bridging the gap between physician and medical student education: using the Train the Trainer model to improve cultural competence training in the clerkship years of medical school. Adv Med Educ Pract 2018; 9:495-498. [PMID: 29983602 PMCID: PMC6023151 DOI: 10.2147/amep.s163485] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cultural competence (CC) training has become a required part of medical education to create future physicians dedicated to decreasing health disparities. However, current training seems to be inadequate as research has demonstrated gaps between CC training and clinical behaviors of students. One aspect that is potentially contributing to this gap is the lack of physician education of CC. Without it being something not only taught in the classroom, but also modeled and taught in the clinical setting, CC will continue to be a theoretical concept instead of a skill set that changes the way that future physicians interact with patients and make decisions about patient care. To change this, we propose the implementation of a Train the Trainer model in which the preclinical professor in charge of CC education trains Clerkship and Residency Directors who then can train and supervise the physicians and residents in their departments on CC to better implement it into the formal and informal curriculum of clerkships.
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Affiliation(s)
- Paige M Anderson
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA,
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Vick AD, Baugh A, Lambert J, Vanderbilt AA, Ingram E, Garcia R, Baugh RF. Levers of change: a review of contemporary interventions to enhance diversity in medical schools in the USA. Adv Med Educ Pract 2018; 9:53-61. [PMID: 29403326 PMCID: PMC5783143 DOI: 10.2147/amep.s147950] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A growing body of research illustrates the importance of aligning efforts across the operational continuum to achieve diversity goals. This alignment begins with the institutional mission and the message it conveys about the priorities of the institution to potential applicants, community, staff, and faculty. The traditional themes of education, research, and service dominate most medical school mission statements. The emerging themes of physician maldistribution, overall primary-care physician shortage, diversity, and cost control are cited less frequently. The importance and salience of having administrative leaders with an explicit commitment to workforce and student diversity is a prominent and pivotal factor in the medical literature on the subject. Organizational leadership shapes the general work climate and expectations concerning diversity, recruitment, and retention. Following the Bakke decision, individual medical schools, supported by the Association of American Medical Colleges, worked to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the rubric of "holistic review", permitted by the US Supreme Court in 2003. A large diverse-applicant pool is needed to ensure the appropriate candidates can be chosen for the incoming medical school class. Understanding the optimal rationale and components for a successful recruitment program is important. Benchmarking with other schools regionally and nationally will identify what should be the relative size of a pool. Diversity is of compelling interest to us all, and should pervade all aspects of higher education, including admissions, the curriculum, student services and activities, and our faculties. The aim of medical education is to cultivate a workforce with the perspectives, aptitudes, and skills needed to fuel community-responsive health-care institutions. A commitment toward diversity needs to be made.
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Affiliation(s)
| | | | | | - Allison A Vanderbilt
- Department of Family Medicine, College of Medicine and Life Science, University of Toledo, Toledo, OH
| | | | | | - Reginald F Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Vanderbilt AA, Pappada SM, Stein H, Harper D, Papadimos TJ. Increasing patient safety with neonates via handoff communication during delivery: a call for interprofessional health care team training across GME and CME. Adv Med Educ Pract 2017; 8:365-367. [PMID: 28652839 PMCID: PMC5476430 DOI: 10.2147/amep.s129674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one's knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum.
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Affiliation(s)
| | - Scott M Pappada
- Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo
| | - Howard Stein
- Department of Pediatrics, ProMedica Toledo Children’s Hospital
| | - David Harper
- Department of Obstetrics and Gynecology, ProMedica Toledo Hospital
| | - Thomas J Papadimos
- Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA
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Cannon SM, Shukla V, Vanderbilt AA. Addressing the healthcare needs of older Lesbian, Gay, Bisexual, and Transgender patients in medical school curricula: a call to action. Med Educ Online 2017; 22:1320933. [PMID: 28468575 PMCID: PMC5419296 DOI: 10.1080/10872981.2017.1320933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Medical students matriculating in the coming years will be faced with treating an expansive increase in the population of older lesbian, gay, bisexual, and transgender (LGBT) patients. While these patients face healthcare concerns similar to their non-LGBT aging peers, the older LGBT community has distinct healthcare needs and faces well-documented healthcare disparities. In order to reduce these healthcare barriers, medical school curricula must prepare and educate future physicians to treat this population while providing high quality, culturally-competent care. This article addresses some of the unique healthcare needs of the aging LGBT population with an emphasis on social concerns and healthcare disparities. It provides additional curricular recommendations to aid in the progressive augmentation of medical school curricula. ABBREVIATIONS Liaison Committee on Medical Education (LCME); LGBT: Lesbian, gay, bisexual, transgender.
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Affiliation(s)
- Sophie M. Cannon
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
- CONTACT Sophie M. Cannon College of Medicine and Life Sciences, The University of Toledo, 3000 Arlington Ave, Toledo, OH43614
| | - Vipul Shukla
- LGBT Health Policy and Practice Graduate Program, George Washington University, Washington, DC, USA
| | - Allison A. Vanderbilt
- Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Vanderbilt AA, Perkins SQ, Muscaro MK, Papadimos TJ, Baugh RF. Creating physicians of the 21st century: assessment of the clinical years. Adv Med Educ Pract 2017; 8:395-398. [PMID: 28694712 PMCID: PMC5491574 DOI: 10.2147/amep.s136664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical education has been under a constant state of revision for the past several years. The overarching theme of the curriculum revisions for medical schools across the USA has been creating better physicians for the 21st century, with the same end result: graduating medical students at the optimal performance level when entering residency. We propose a robust, thorough assessment process that will address the needs of clerkships, residents, students, and, most importantly, medical schools to best measure and improve clinical reasoning skills that are required for the learning outcomes of our future physicians. The Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical school graduates based on competency-based outcomes and the assessment of specialty-specific milestones; however, there is some evidence that medical school graduates do not consistently meet the Level 1 milestones prior to entering/beginning residency, thus starting their internship year underprepared and overwhelmed. Medical schools should take on the responsibility to provide competency-based assessments for their students during the clinical years. These assessments should be geared toward preparing them with the cognitive competencies and skills needed to successfully transition to residency. Then, medical schools can produce students who will ultimately be prepared for transition to their residency programs to provide quality care.
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Affiliation(s)
- Allison A Vanderbilt
- Department of Family Medicine
- Correspondence: Allison A Vanderbilt, Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, 3000 Arlington Ave, MS 1050, Toledo, OH 43626, USA, Email
| | - Sara Q Perkins
- College of Medicine and Life Sciences, University of Toledo
| | | | | | - Reginald F Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Mayer SD, Peterfy E, Crossman SH, Phipps LB, Vanderbilt AA. Patient-centeredness and empathy in a bilingual interprofessional primary care teaching clinic: a pilot study. J Multidiscip Healthc 2016; 9:395-400. [PMID: 27601915 PMCID: PMC5003591 DOI: 10.2147/jmdh.s107851] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Utilizing the Consultation and Relational Empathy survey, this project examined the perceptions of care team empathy and patient-centeredness between English- and Spanish-speaking patients. From fall through spring semesters, patient surveys from a primary care, interprofessional student-led teaching clinic were collected and analyzed. Overall, mean scores for both English- and Spanish-speaking patients were above the reported normative average for general practitioners. While, overall, patients expressed satisfaction with the student-led teaching clinic in terms of empathy and patient-centeredness, English-speaking patients had higher median scores than Spanish-speaking patients. Analyzed individually, questions related to communication and provider attitudes were scored lower by Spanish-speaking patients. These results demonstrate that student-led clinics can deliver patient-centered care and highlight the continuing need to investigate and address disparities between English- and Spanish-speaking patients with regard to feelings of empathy and patient-centeredness.
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Affiliation(s)
- Sallie D Mayer
- Bon Secours Virginia Health System, Bon Secours Medical Group, Midlothian, VA
| | - Erika Peterfy
- School of Pharmacy, Virginia Commonwealth University, Charlotte, NC
| | - Steven H Crossman
- Department of Family Medicine and Population Health, College of Medicine
| | - Lisa Burroughs Phipps
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA
| | - Allison A Vanderbilt
- Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Vanderbilt AA, Jain S, Mayer SD, Gregory AA, Ryan MH, Bradner MK, Baugh RF. Clinical records organized and optimized for clinical integration and clinical decision making. Int J Med Educ 2016; 7:242-5. [PMID: 27447334 PMCID: PMC4958347 DOI: 10.5116/ijme.576a.fff4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/22/2016] [Indexed: 05/25/2023]
Affiliation(s)
| | - Samay Jain
- Division of Urologic Oncology, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Sallie D. Mayer
- Department of Pharmacy, Bon Secours,Virginia Health System, Midlothian, VA, USA
| | - Allison A. Gregory
- Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, USA
| | - Mark H. Ryan
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, USA
| | - Melissa K. Bradner
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, USA
| | - Reginald F. Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
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Bradner M, Harper DV, Ryan MH, Vanderbilt AA. 'Don't play the butter notes': jazz in medical education. Med Educ Online 2016; 21:30582. [PMID: 27095009 PMCID: PMC4837326 DOI: 10.3402/meo.v21.30582] [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] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/30/2016] [Indexed: 06/05/2023]
Abstract
Jazz has influenced world music and culture globally - attesting to its universal truths of surviving, enduring, and triumphing over tragedy. This begs the question, what can we glean in medical education from this philosophy of jazz mentoring? Despite our training to understand disease and illness in branching logic diagrams, the human experience of illness is still best understood when told as a story. Stories like music have tempos, pauses, and silences. Often they are not linear but wrap around the past, future, and back to the present, frustrating the novice and the experienced clinician in documenting the history of present illness. The first mentoring lesson Hancock discusses is from a time he felt stuck with his playing - his sound was routine. Miles Davis told him in a low husky murmur, 'Don't play the butter notes'. In medical education, 'don't play the butter notes' suggests not undervaluing the metacognition and reflective aspects of medical training that need to be fostered during the early years of clinical teaching years.
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Affiliation(s)
- Melissa Bradner
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA;
| | - Darryl V Harper
- Department of Music, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark H Ryan
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Allison A Vanderbilt
- Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Vanderbilt AA, Baugh RF, Hogue PA, Brennan JA, Ali II. Curricular integration of social medicine: a prospective for medical educators. Med Educ Online 2016; 21:30586. [PMID: 26782722 PMCID: PMC4716551 DOI: 10.3402/meo.v21.30586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 05/05/2023]
Abstract
In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.
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Affiliation(s)
- Allison A Vanderbilt
- Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA;
| | - Reginald F Baugh
- Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Patricia A Hogue
- Department of Physician Assistant Studies, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Julie A Brennan
- Family Medicine and Division, Adult Psychiatry, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Imran I Ali
- Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Ryan MH, Yoder J, Flores SK, Soh J, Vanderbilt AA. Using Health Information Technology to Reach Patients in Underserved Communities: A Pilot Study to Help Close the Gap With Health Disparities. Glob J Health Sci 2015; 8:86-94. [PMID: 26755484 PMCID: PMC4954914 DOI: 10.5539/gjhs.v8n6p86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction: In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information, especially for patients with limited access to care. Strategies for using health IT to enhance communication between providers and patients in low-income communities can be incorporated into undergraduate medical education (UME) curriculum. Methods: A pilot study was conducted to determine if IT could serve as an effective means of communication with patients at a free clinic where 100% of the patients are uninsured; the clinic is located in an urban setting and primarily serves Latinos, the working poor, and the homeless. An anonymous survey was administered to patients to assess rates of IT ownership, general IT use, and IT use for health and medical information. Results: The majority of study participants owned a cell phone (92%); one-third used their cell phone to access health or medical information (38%). Most study participants reported using the Internet (72%), and two-thirds had used the Internet to obtain health and medical information (64%). Conclusion: Given the difficulties faced by low income and medically underserved communities in accessing healthcare services, the use of IT tools may improve their’ access to health information in ways that could enhance patient knowledge and self-management, and perhaps positively impact health outcomes. Therefore, it is essential to incorporate use of IT tools in training for medical students and residents to enhance communication with patients in underserved communities.
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Affiliation(s)
- Mark H Ryan
- Department of Family Medicine and Population Health, International/Inner City/Rural Preceptorship (I2CRP), Virginia Commonwealth University, Richmond, Virginia, USA.
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Vanderbilt AA, Wright MS, Brewer AE, Murithi LK, Coney P. Increasing Knowledge and Health Literacy about Preterm Births in Underserved Communities: An Approach to Decrease Health Disparities, a Pilot Study. Glob J Health Sci 2015; 8:83-9. [PMID: 26234992 PMCID: PMC4804064 DOI: 10.5539/gjhs.v8n1p83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. For example, health disparities between ethnic and racial groups continue to grow due to the widening gap in large declines in infant and fetal mortality among Caucasians compared to Black non-Hispanic or African Americans. According to the American Congress of Obstetricians and Gynecologists, preterm birth remains a leading cause of infant morbidity and mortality. The purpose of our study is to determine if the computer-based educational modules related to preterm birth health literacy and health disparity with a pre-test and post-test can effectively increase health knowledge of our participants in targeted underserved communities within the Richmond-metro area. METHODS This was a pilot study in the Richmond-Metro area. Participants were required to be over the age of 18, and had to electronically give consent. Descriptive statistics, means and standard deviations, and Paired t-tests were conducted in SPSS 22.0. RESULTS There were 140 participants in the pilot study. P<.05 was set as significant and all four modules had a P<.000. The males were not significant with modules: Let's Talk Patient & Provider Communication P<.132 and It Takes a Village P<.066. Preterm birth status yes all of the findings were statistically significant P<.000. Preterm birth status no Let's Talk Patients & Provider Communication was not significant P<.106. CONCLUSION Overall, researchers found that with a strong research methodology and strong content relevant to the community, the participants demonstrated an increase in their knowledge in health literacy and preterm birth.
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Ryan M, Vanderbilt AA, Mayer SD, Gregory A. Interprofessional education as a method to address health needs in a Hispanic community setting: A pilot study. J Interprof Care 2015; 29:515-7. [PMID: 25973668 DOI: 10.3109/13561820.2015.1020360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/13/2022]
Abstract
The Hispanic population in and around Richmond, Virginia, USA, has grown rapidly since 2000. The Richmond City Latino Needs Assessment emphasized this growth and also reported concerns regarding healthcare access. Schools of medicine, pharmacy, and nursing at Virginia Commonwealth University have partnered together with community organizations to develop and implement an interprofessional student service learning pilot program to meet community needs and provide an opportunity for enhanced learning. Community events allowed students to work on interprofessional teams to provide healthcare screenings and education to the Hispanic community. The program was evaluated by the use of a community service survey. Results indicated improved perceptions of student comfort with working with diverse patients, working on teams, and patient-centered care, as well as statistically significant improvements in student understanding of health care access and barriers, community needs, and social determinants of health. Results suggest that this community-based service-learning interprofessional experience was critical in student learning.
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Affiliation(s)
- Mark Ryan
- a Department of Family Medicine and Population Health , School of Medicine
| | | | - Sallie D Mayer
- c Department of Pharmacotherapy & Outcomes Science , and
| | - Allison Gregory
- d Department of Family and Community Health Nursing , School of Nursing, Virginia Commonwealth University , Richmond , VA , USA
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Vanderbilt AA, Dail MD, Jaberi P. Reducing health disparities in underserved communities via interprofessional collaboration across health care professions. J Multidiscip Healthc 2015; 8:205-8. [PMID: 25960659 PMCID: PMC4411015 DOI: 10.2147/jmdh.s74129] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. Health disparities are pervasive across the United States and no single health care profession can tackle this national crisis alone. It is essential that all health care providers work collaboratively toward the overarching goal of systematically closing the health disparities gap. Interprofessional collaboration is the foundation needed for health care providers to support patient needs and reduce health disparities in public health. Let us reach across the silos we work within and collaborate with our colleagues. Stand up and begin thinking about our communities, our patients, and the future overall health status of the population for the United States.
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Affiliation(s)
- Allison A Vanderbilt
- Center on Health Disparities, Virginia Commonwealth University, Richmond, VA, USA
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael D Dail
- Family Health Clinic, McDonald Army Health Center, Fort Eustis, VA, USA
| | - Parham Jaberi
- Virginia Department of Health, Chesterfield Health District, Chesterfield, VA, USA
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Murithi LK, Masho SW, Vanderbilt AA. Factors enhancing utilization of and adherence to prevention of mother-to-child transmission (PMTCT) service in an urban setting in Kenya. AIDS Behav 2015; 19:645-54. [PMID: 25381562 DOI: 10.1007/s10461-014-0939-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing to high numbers of children living with HIV globally and is among the 22 PMTCT global plan priority countries. Using structured and in-depth interviews this study examined enabling factors that enhance utilization of and adherence to PMTCT services in an urban setting in Kenya. HIV-positive birthmothers (N = 55) whose infants were HIV-negative at the time of the study completed a structured interview and a subset (n = 15) participated in in-depth interviews. The majority of the mothers (98 %) delivered at a health facility and 91 % exclusively breastfed. Further, 91 % attended clinic appointments regularly and 69.1 % strictly adhered to prescribed medication dosage and schedules. However, 18 % had not disclosed their HIV status to anybody, 27 % did not use condom during sex, 95 % did not participate in AIDS support groups and 53 % of their male partners were not involved in PMTCT. Four key themes facilitating PMTCT success emerged from the qualitative data: supportive counseling, striving for motherhood, assurance of confidentiality; and confirmation, affirmation and admiration. HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to reach out for support from family and community, apply acquired knowledge and access more affordable care. To be successful, PMTCT programs should be aware of these factors and ensure that mothers are provided with culturally competent care.
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Affiliation(s)
- Lydia Karuta Murithi
- Department of Family Medicine and Population Health/Center on Health Disparities, Virginia Commonwealth University School of Medicine, 730 East Broad Street, PO Box 98050, Richmond, VA, 23298-0501, USA,
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Bradner MK, Crossman SH, Gary J, Vanderbilt AA, VanderWielen L. Beyond diagnoses: family medicine core themes in student reflective writing. Fam Med 2015; 47:182-186. [PMID: 25853528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES We share qualitative study results of third-year medical student writings during their family medicine clerkship utilizing a reflective writing exercise from 2005 and 2013. METHODS For this paper, 50 student writings were randomly selected from the 2005 cohort in addition to 50 student writings completed by the 2013 cohort. Deductive thematic analysis utilizing Atlas.ti software was completed utilizing the Future of Family Medicine core attributes of family physicians as the a priori coding template. RESULTS Student writings actively reflect key attributes of family physicians as described by the Future of Family Medicine Report: a deep understanding of the dynamics of the whole person, a generative impact on patients' lives, a talent for humanizing the health care experience, and a natural command of complexity and multidimensional access to care. CONCLUSIONS We discuss how to lead the writing exercise and provide suggestions for facilitating the discussion to bring out these important aspects of family medicine care.
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Affiliation(s)
- Melissa K Bradner
- Department of Family Medicine and Population Health, Virginia Commonwealth University
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VanderWielen LM, Vanderbilt AA, Crossman SH, Mayer SD, Enurah AS, Gordon SS, Bradner MK. Health disparities and underserved populations: a potential solution, medical school partnerships with free clinics to improve curriculum. Med Educ Online 2015; 20:27535. [PMID: 25907001 PMCID: PMC4408316 DOI: 10.3402/meo.v20.27535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 02/09/2015] [Accepted: 03/10/2015] [Indexed: 05/02/2023]
Abstract
Health-care educators share the social responsibility to teach medical students about social determinants of health and health-care disparities and subsequently to encourage medical students to pursue residencies in primary care and medical practice in underserved communities. Free clinics provide care to underserved communities, yet collaborative partnerships with such organizations remain largely untapped by medical schools. Free clinics and medical schools in 10 US states demonstrate that such partnerships are geographically feasible and have the potential to mutually benefit both organizational types. As supported by prior research, students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.
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Affiliation(s)
- Lynn M VanderWielen
- Department of Family Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, USA;
| | - Allison A Vanderbilt
- Center on Health Disparities, Virginia Commonwealth University, Richmond, VA, USA
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H Crossman
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sallie D Mayer
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Alexander S Enurah
- Division of Internal Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Samuel S Gordon
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Melissa K Bradner
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Vanderbilt AA, Grover AC, Pastis NJ, Feldman M, Granados DD, Murithi LK, Mainous AG. Randomized controlled trials: a systematic review of laparoscopic surgery and simulation-based training. Glob J Health Sci 2014; 7:310-27. [PMID: 25716408 PMCID: PMC4493882 DOI: 10.5539/gjhs.v7n2p310] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 01/22/2023] Open
Abstract
Introduction: This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs. Methods: This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR). Results: This systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies). Conclusion: Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum.
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VanderWielen LM, Enurah AS, Rho HY, Nagarkatti-Gude DR, Michelsen-King P, Crossman SH, Vanderbilt AA. Medical interpreters: improvements to address access, equity, and quality of care for limited-English-proficient patients. Acad Med 2014; 89:1324-7. [PMID: 25054413 DOI: 10.1097/acm.0000000000000296] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Limited-English-proficient (LEP) patients in the United States experience a variety of health care disparities associated with language barriers, including reduced clinical encounter time and substandard medical treatment compared with their English-speaking counterparts. In most current U.S. health care settings, interpretation services are provided by personnel ranging from employed professional interpreters to untrained, ad hoc interpreters such as friends, family, or medical staff. Studies have demonstrated that untrained individuals commit many interpretation errors that may critically compromise patient safety and ultimately prove to be life-threatening. Despite documented risks, the U.S. health care system lacks a required standardized certification for medical interpreters. The authors propose that the standardization of medical interpreter training and certification would substantially reduce the barriers to equitable care experienced by LEP patients in the U.S. health care system, including the occurrence of preventable clinical errors. Recent efforts of the U.S. federal court system are cited as a successful and realistic example of how these goals may be achieved. As guided by the evolution of the federal court interpreting certification program, subsequent research will be required to demonstrate the improvements and challenges that would result from national certification standards and policy for medical interpreters. Research should examine cost-effectiveness and ensure that certified interpreting services are appropriately used by health care practitioners. Ongoing commitment is required from lawmakers, health care providers, and researchers to remove barriers to care and to demand that equity remain a consistent goal of our health care system.
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Affiliation(s)
- Lynn M VanderWielen
- Dr. VanderWielen is an instructor at the University of Colorado School of Medicine, Department of Family Medicine, Denver, Colorado. Dr. Enurah is an internal medicine intern at the University Of Colorado School Of Medicine, Denver, Colorado. Dr. Rho is a family medicine/internal medicine intern at Eastern Virginia Medical School, Norfolk, Virginia. Dr. Nagarkatti-Gude is a psychiatry intern at Oregon Health and Science University, Portland, Oregon. Ms. Michelsen-King is a federally certified Spanish court interpreter and master test specialist of federal and state consortium Spanish interpreter certification examinations, and collateral instructor of medical and court Spanish interpreting, Virginia Commonwealth University School of World Studies, Richmond, Virginia. Dr. Crossman is associate professor of family medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. Dr. Vanderbilt is director of assessment and evaluation, Virginia Commonwealth University School of Medicine Center on Health Disparities, Richmond, Virginia
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Isringhausen KT, VanderWielen LM, Vanderbilt AA. Addressing health care disparities and access to dental care while improving education: schools of dentistry and federally qualified health centers. J Health Care Poor Underserved 2014; 25:670-4. [PMID: 24858876 DOI: 10.1353/hpu.2014.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oral health disparities in the United States are a result of economic, educational, and social barriers faced by vulnerable and underserved individuals. The oral health care infrastructure is continuously challenged to provide access to quality care with a shortage of dental professionals and expanding oral health disparities. Federally qualified health centers (FQHC) provide oral health care in underserved communities, while schools of dentistry strive to provide students and residents with experience in underserved communities to address access to care issues and produce oral health professionals who will practice in these communities. Formal partnerships between these organizations have the potential to address oral health disparities, access to dental care and improve dental education and training. Utilizing ArcGIS (ArcMAP) software, dental schools and FQHC services sites located in the continental United States were geocoded to demonstrate geographic feasibility: on average, dental schools are within 10 miles of 34 FQHC service sites.
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VanderWielen LM, Vanderbilt AA, Dumke EK, Do EK, Isringhausen KT, Wright MS, Enurah AS, Mayer SD, Bradner M. Improving public health through student-led interprofessional extracurricular education and collaboration: a conceptual framework. J Multidiscip Healthc 2014; 7:105-10. [PMID: 24550677 PMCID: PMC3926462 DOI: 10.2147/jmdh.s52019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Indexed: 12/25/2022] Open
Abstract
In the US, health care professionals are trained predominantly in uniprofessional settings independent of interprofessional education and collaboration. Yet, these professionals are tasked to work collaboratively as part of an interprofessional team in the practice environment to provide comprehensive care to complex patient populations. Although many advantages of interprofessional education have been cited in the literature, interprofessional education and collaboration present unique barriers that have challenged educators and practitioners for years. In spite of these impediments, one student-led organization has successfully implemented interprofessional education and cross-disciplinary collaboration. The purpose of this paper is to provide a conceptual framework for successful implementation of interprofessional education and collaboration for other student organizations, as well as for faculty and administrators. Each member of the interprofessional team brings discipline-specific expertise, allowing for a diverse team to attend to the multidimensional health needs of individual patients. The interprofessional team must organize around a common goal and work collaboratively to optimize patient outcomes. Successful interdisciplinary endeavors must address issues related to role clarity and skills regarding teamwork, communication, and conflict resolution. This conceptual framework can serve as a guide for student and health care organizations, in addition to academic institutions to produce health care professionals equipped with interdisciplinary teamwork skills to meet the changing health care demands of the 21st century.
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Affiliation(s)
- Lynn M VanderWielen
- School of Allied Health Professions, Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
| | - Allison A Vanderbilt
- Center of Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Erika K Dumke
- Division for Health Sciences Diversity, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth K Do
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Kim T Isringhausen
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Marcie S Wright
- Center of Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Sallie D Mayer
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa Bradner
- Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Vanderbilt AA, Mayglothling J, Pastis NJ, Franzen D. A review of the literature: direct and video laryngoscopy with simulation as educational intervention. Adv Med Educ Pract 2014; 5:15-23. [PMID: 24501548 PMCID: PMC3912064 DOI: 10.2147/amep.s51963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A review of the literature was conducted to analyze the impact of simulation-based training for direct and video laryngoscopy (VL) skills for health care professionals and health care students. METHODS This review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop airway management skills and identify pertinent literature by searching PubMed from inception of the database up to July 2013. This current review addresses the question of whether airway management simulation-based training improves the acquisition of resuscitation skills for health care profession learners. RESULTS A total of eleven articles qualified for this systematic review based on the inclusion and exclusion criteria. These studies were analyzed and the specific simulators, participants, assessments, and details related to: time of intubation; Cormack and Lehane classification; success and failure rate; and number of attempts. CONCLUSION This review suggests that simulation-based training is one effective way to teach VL skills. VL allows for a higher success rate, faster response time, and a decrease in the number of attempts by health care students and health care professionals under the conditions based on the eleven studies reviewed.
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Affiliation(s)
| | | | - Nicholas J Pastis
- Division of Pulmonary and Critical Care, Medical University of South Carolina, SC, USA
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Vanderbilt AA, Husson MM. Current sedation and anesthesia practices among dentists: a statewide survey. Oral Health Dent Manag 2013; 12:230-236. [PMID: 24390021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The purpose of this survey was to describe the current sedation training and practices among dentists in the state of Virginia, and to determine what areas of sedation training may need to be improved or maintained. METHODS A survey was developed by two faculty members at the VCU School of Medicine and School of Dentistry, focused on sedation practices of dentists within the state of Virginia. The survey contained several key domains: background, education and training, implementation in practice, and continuing education. The survey consisted of thirty questions. RESULTS Four hundred and thirty nine dentists responded of the 1,982 (22% response rate) surveys were completed and used in analysis. Almost half of the dentists that responded use oral medication to administer sedation within their office and of those 67% re-dose the oral sedative medication to the patient. Over 75% of dentists indicated that they have had some type of sedation related emergency in their office; despite this number, 11% reported that they do not practice for sedation emergency scenarios. Over 70% of dentists reported that they solely monitor their patient during simultaneous sedation and dental treatment, while others reported having a dental assistant (20%) or other medical provider (10%) assisting with monitoring while they are providing dental care. CONCLUSION With 75% of dentists that responded to the survey practicing sedation, experiencing some type of medical emergency related to sedations, and 4% of these not using any type of patient monitoring system, all providers offering sedation should follow the monitoring guidelines set forth by the ADA and/or AAPD. With an increase in demand from patients for sedation services during dental procedures, additional training should be recommended to dentists to assure that they have the skills and knowledge necessary to rescue a patient should a medical emergency arise.
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Affiliation(s)
- Allison A Vanderbilt
- Center on Health Disparities, School of Medicine, Virginia Commonwealth University, 730 East Broad St. Suite 4132, Richmond, VA 23298, USA, Tel: 804-828-2805; Fax: 804-628-9961; e-mail:
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Vanderbilt AA, Wright MS. Infant mortality: a call to action overcoming health disparities in the United States. Med Educ Online 2013; 18:22503. [PMID: 24029082 PMCID: PMC3772318 DOI: 10.3402/meo.v18i0.22503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Among all of the industrialized countries, the United States has the highest infant mortality rate. Racial and ethnic disparities continue to plague the United States with a disproportionally high rate of infant death. Furthermore, racial disparities among infant and neonatal mortality rates remain a chronic health problem in the United States. These risks are based on the geographical variations in mortality and disparities among differences in maternal risk characteristics, low birth weights, and lack of access to health care.
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Affiliation(s)
- Allison A Vanderbilt
- Assessment and Evaluation, Center on Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Bradner M, Crossman SH, Vanderbilt AA, Gary J, Munson P. Career advising in family medicine: a theoretical framework for structuring the medical student/faculty advisor interview. Med Educ Online 2013; 18:21173. [PMID: 23948497 PMCID: PMC3756303 DOI: 10.3402/meo.v18i0.21173] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/21/2013] [Indexed: 05/14/2023]
Abstract
BACKGROUND There are unique challenges to recruiting students into the specialty of family medicine within academic medical centers. METHODS At Virginia Commonwealth University, we developed an advising framework to help students address institutional and personal obstacles to choosing family medicine as a career. RESULTS The role of a faculty advisor is not to direct the student to a career choice but rather to foster a mentor relationship and help the student come to his or her own realizations regarding career choice. The faculty advisor/medical student interview is conceptualized as five discussion topics: self-knowledge, perception, organizational voice, cognitive dissonance, and anticipatory counseling. CONCLUSION This framework is intended to assist faculty in their efforts to encourage students to consider a career in family medicine.
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Affiliation(s)
- Melissa Bradner
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
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VanderWielen LM, Enurah AS, Osburn IF, LaCoe KN, Vanderbilt AA. The development of student-led interprofessional education and collaboration. J Interprof Care 2013; 27:422-3. [DOI: 10.3109/13561820.2013.790882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ryan MS, Vanderbilt AA, Lewis TW, Madden MA. Benefits and barriers among volunteer teaching faculty: comparison between those who precept and those who do not in the core pediatrics clerkship. Med Educ Online 2013; 18:1-7. [PMID: 23643334 PMCID: PMC3644623 DOI: 10.3402/meo.v18i0.20733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 02/28/2013] [Accepted: 03/28/2013] [Indexed: 05/27/2023]
Abstract
BACKGROUND Community-based outpatient experiences are a core component of the clinical years in medical school. Central to the success of this experience is the recruitment and retention of volunteer faculty from the community. Prior studies have identified reasons why some preceptors volunteer their time however, there is a paucity of data comparing those who volunteer from those who do not. METHODS A survey was developed following a review of previous studies addressing perceptions of community-based preceptors. A non-parametric, Mann-Whitney U test was used to compare active preceptors (APs) and inactive preceptors (IPs) and all data were analyzed in SPSS 20.0. RESULTS There was a 28% response rate. Preceptors showed similar demographic characteristics, valued intrinsic over extrinsic benefits, and appreciated Continuing Medical Education (CME)/Maintenance of Certification (MOC) opportunities as the highest extrinsic reward. APs were more likely to also precept at the M1/M2 level and value recognition and faculty development opportunities (p<0.05). IPs denoted time as the most significant barrier and, in comparison to APs, rated financial compensation as more important (p<0.05). CONCLUSIONS Community preceptors are motivated by intrinsic benefits of teaching. Efforts to recruit should initially focus on promoting awareness of teaching opportunities and offering CME/MOC opportunities. Increasing the pool of preceptors may require financial compensation.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA.
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Vanderbilt AA, Isringhausen KT, VanderWielen LM, Wright MS, Slashcheva LD, Madden MA. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care. Med Educ Online 2013; 18:1-3. [PMID: 23534859 PMCID: PMC3609999 DOI: 10.3402/meo.v18i0.20644] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 02/19/2013] [Accepted: 02/22/2013] [Indexed: 05/18/2023]
Abstract
Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.
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Affiliation(s)
- Allison A Vanderbilt
- Center on Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Vanderbilt AA, Feldman M, Wood IK. Assessment in undergraduate medical education: a review of course exams. Med Educ Online 2013; 18:1-5. [PMID: 23469935 PMCID: PMC3591508 DOI: 10.3402/meo.v18i0.20438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 01/15/2013] [Accepted: 02/14/2013] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The purpose of this study is to describe an approach for evaluating assessments used in the first 2 years of medical school and report the results of applying this method to current first and second year medical student examinations. METHODS Three faculty members coded all exam questions administered during the first 2 years of medical school. The reviewers discussed and compared the coded exam questions. During the bi-monthly meetings, all differences in coding were resolved with consensus as the final criterion. We applied Moore's framework to assist the review process and to align it with National Board of Medical Examiners (NBME) standards. RESULTS The first and second year medical school examinations had 0% of competence level questions. The majority, more than 50% of test questions, were at the NBME recall level. CONCLUSION It is essential that multiple-choice questions (MCQs) test the attitudes, skills, knowledge, and competency in medical school. Based on our findings, it is evident that our exams need to be improved to better prepare our medical students for successful completion of NBME step exams.
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Affiliation(s)
- Allison A Vanderbilt
- Center on Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Vanderbilt AA, Isringhausen KT, Bonwell PB. Interprofessional education: the inclusion of dental hygiene in health care within the United States - a call to action. Adv Med Educ Pract 2013; 4:227-9. [PMID: 24235854 PMCID: PMC3826930 DOI: 10.2147/amep.s51962] [Citation(s) in RCA: 11] [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: 05/19/2023]
Abstract
There is a lack of access to oral health care in the United States for rural, underserved, uninsured, and low-income populations. There are widely recognized problems with the US health care system, including rapidly increasing costs and access to oral health. During the last decade, there has been a huge influx and push toward interprofessional education programs; however, these programs conveniently leave out dental hygiene. Interprofessional education can bring forth the collaboration, communication, and teamwork necessary to provide a comprehensive health care plan to treat oral health care needs in patients. As the advanced practice for dental hygiene emerges, it is imperative that the educational qualifications of dental hygienists are sufficient to enable them to safely provide the scope of services and care encompassed in these new expanded roles and to effectively participate as an interprofessional team member.
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Affiliation(s)
- Allison A Vanderbilt
- Center on Health Disparities and School of Medicine, Richmond, VA, USA
- Correspondence: Allison A Vanderbilt, Virginia Commonwealth University, Theatre Row Building, 730 East Broad St, Suite 4116, Richmond, VA 23298, USA, Tel +1 804 828 2805, Email
| | - Kim T Isringhausen
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Richmond, VA, USA
| | - Patricia Brown Bonwell
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Richmond, VA, USA
- Dental Hygiene Program, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
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Abstract
Competency-based assessment and an emphasis on obtaining higher-level outcomes that reflect physicians' ability to demonstrate their skills has created a need for more advanced assessment practices. Simulation-based assessments provide medical education planners with tools to better evaluate the 6 Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) core competencies by affording physicians opportunities to demonstrate their skills within a standardized and replicable testing environment, thus filling a gap in the current state of assessment for regulating the practice of medicine. Observational performance assessments derived from simulated clinical tasks and scenarios enable stronger inferences about the skill level a physician may possess, but also introduce the potential of rater errors into the assessment process. This article reviews the use of simulation-based assessments for certification, credentialing, initial licensure, and relicensing decisions and describes rater training strategies that may be used to reduce rater errors, increase rating accuracy, and enhance the validity of simulation-based observational performance assessments.
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Affiliation(s)
- Moshe Feldman
- School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA.
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Schaefer JJ, Vanderbilt AA, Cason CL, Bauman EB, Glavin RJ, Lee FW, Navedo DD. Literature review: instructional design and pedagogy science in healthcare simulation. Simul Healthc 2011; 6 Suppl:S30-41. [PMID: 21817861 DOI: 10.1097/sih.0b013e31822237b4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool. However, there are well-designed research studies that address the translation into clinical settings and have positive patient safety outcomes.
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Affiliation(s)
- John J Schaefer
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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