An Introduction to Structural Competency for Haitian-Identified Patients: History, Culture, and Access to Care

INTRODUCTION

The Haitian population within the US represents the largest diaspora outside of Haiti, with most Haitians residing in major urban communities. Despite clear differences in health outcomes specific to Haitians, the community has traditionally been aggregated into the general Black population. To address specific health disparities, this workshop was designed to distinguish and elaborate on the health care problems affecting Haitians.

METHODS

We created an interactive 60-minute workshop including a PowerPoint presentation, two case presentations, and a 5-minute informational video to bring awareness of the historical perspectives impacting Haitian/Haitian American health, access to care, and health care disparities to providers. Knowledge was assessed by pre- and postworkshop evaluation forms. The module was aimed at health care professional learners.

RESULTS

Seventy-four people with diverse ethnoracial identities, including medical students, residents, academic faculty, physicians, nonmedical graduate students, and health care staff and administrators, attended three workshops. All learning objectives were met, with pre- and postworkshop data indicating a statistically significant increase in participants' reported confidence. Workshop attendees commented positively on the group discussion component, the workshop's interactive nature, the opportunity to apply taught knowledge to case presentations, and the historical context provided.

DISCUSSION

As the number of Haitian immigrants continues to rise throughout US urban communities, providers must increase their culture competency in training and delivery to improve care for a major population. This module can help better prepare health care providers and trainees to offer competent care to Haitian/Haitian American patients.

Gender Distribution of Deans Among US Medical Schools: Towards Equity in Academic Medicine

BACKGROUND

Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US).

METHODS

A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05.

RESULTS

Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0 vs. 55.2, P = 0.001) and H-index (43.2 vs. 25.7, P = 0.001); however, there are no differences in the mean number of NIH grants (27.5 vs. 19.1, P = 0.323) nor mean total NIH funding received ($18,931,336 vs. $14,289,529, P = 0.524). While significant differences in mean H-index between all US regions were found (P = 0.002), no significant differences exist between major US regions regarding the mean lifetime publication count (P = 0.223), NIH grants received (P = 0.200), nor total NIH funding (P = 0.824) received.

CONCLUSION

A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions.

Society on NeuroImmune Pharmacology COVID-19 Virtual Workshop

Abstract

This brief report collects the program and abstracts of the Society on NeuroImmune Pharmacology (SNIP) COVID-19 Virtual Workshop held on April 9, 2021. The workshop consisted of four symposia: Symposium 1: Molecular approaches to COVID-19 pathogenesis and underlying mechanisms; Symposium 2: Therapeutic and vaccine approaches to COVID-19; Symposium 3: Early Career Investigator talks; and Symposium 4: Diversity and Inclusion SNIP Committee (DISC) program: Well-being and reflections. The workshop also featured four special talks on COVID-19 and funding opportunities from the National Institute on Alcohol Abuse and Alcoholism (NIAAA); COVID-19 and funding opportunities from the National Institute on Drug Abuse (NIDA); opportunities from NIH for early career investigator (ECI) fellows; and neurologic and psychiatric complications of SARS-CoV-2 infection. Presenters included NIH officials, SNIP members, and non-member scientists whose abstracts were submitted and accepted for inclusion in the virtual event hosted by the University of Nebraska Medical Center via Zoom webinar. A special theme issue of SNIP's official journal, the Journal of Neuroimmune Pharmacology (JNIP), will collect select papers from the workshop along with other related manuscripts in a special theme issue titled "Neuroimmune Pharmacology of SARS-CoV-2.”

Graphical abstract

How Assumptions and Preferences Can Affect Patient Care: An Introduction to Implicit Bias for First-Year Medical Students

INTRODUCTION

Instruction in implicit bias is becoming prevalent across the spectrum of medical training. Little education exists for preclinical students, and guidance for faculty to facilitate such education is minimal. To address these gaps, we designed and delivered a single session for incoming first-year medical students and developed a facilitator training program.

METHODS

One faculty member delivered a 1-hour, multimedia, interactive lecture to all first-year medical students. Students subsequently met in small groups with trained facilitators. Activities included reflection, guided debriefing, and strategy identification to become aware of when they might be making an assumption causing them to jump to a conclusion about someone. The program evaluation consisted of aggregated student strategies and facilitator feedback during postsession debriefs, both analyzed through thematic analysis.

RESULTS

We delivered instruction to 1,098 students. Student strategies resulted in three themes: (1) humility, (2) reflection, and (3) partnering. The postsession debriefs uncovered opportunities to enhance the session. Lessons learned included presenting material to an entire class at once, allowing students to engage in dynamic discussion in the small groups, eliminating anonymous polling in the small groups, and highlighting management of implicit bias as essential to professional development.

DISCUSSION

Our instructional design enabled first-year medical students to identify at least one strategy to use when implicit biases are activated. The large-group session was deliverable by one faculty member, and volunteers successfully facilitated small-group sessions after only one training session, making this model a feasible innovation to reach an entire medical school class at the same time.

Interactive Session for Residents and Medical Students on Dermatologic Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients

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.

Who We Are Today: a National Survey of Diversity Among Psychiatry Program Directors

OBJECTIVE

In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee's goals was to understand the AADPRT membership's composition and their perceptions of D&I. This study's objective was to identify the demographic characteristics of the AADPRT membership.

METHODS

Program directors were invited by email to participate in an anonymous survey. The survey collected participants' demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program's community setting.

RESULTS

Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community.

CONCLUSIONS

This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study's findings. Potential concerns requiring exploration include the possibility of the program director role serving as a "glass ceiling" for some women and a "leaky pipeline" in academia for groups underrepresented in medicine.

Disability and Ableism in Medicine: A Curriculum for Medical Students

INTRODUCTION

Individuals with disabilities (approximately 20% of the population) experience discrimination and health disparities. Medical school must equip students with expertise to care for patients with disabilities and to identify ableism. Yet, few schools provide curricula that offer a sociopolitical lens for understanding this topic. We developed a disability and ableism curriculum to address this gap.

METHODS

We developed a mandatory 2-hour session for first-year medical students at University of California San Francisco. Activities included: privilege awareness, student-led discussions, and intervention brainstorming for overcoming health care barriers/biases. The session was evaluated through pre/postsurveys, as well as a follow-up survey 1 year later.

RESULTS

In feedback collected during 2018 and 2019, students described the session as meaningful and relevant. Faculty facilitators reported that the session provoked powerful student-centered learning, leadership, and widespread participation. On average the students rated the session 4.6 on a 5-point scale. Pre- and postsession data analysis indicated significant increases in students' self-reported understanding of ableism (p < .001) and confidence in assessing barriers to care for patients with disability (p < .001). One year later, students reported that the session had influenced their conceptualization of providing care to patients with disabilities.

DISCUSSION

Through innovative and participatory activities, this small-group session introduced students to important topics such as ableism, the social model of disability, disability history and culture, and health disparities. Our work suggested that creating curricula to equip students with structural frameworks for understanding disability-a topic underrepresented in medical curricula-stimulated student interest and commitment.

Closing the Gap in Health Care: A Personal Odyssey

This narrative provides insight into medical education for Black physicians in South Carolina in the 1960s, during the civil rights movement. It also discusses the many rewards and challenges of being a physician of color, describes what has been done to develop programs that benefit minority communities, and argues that more such programs are needed.

The Use of Racial Categories in Precision Medicine Research

Scholars have shown that promoting diversity and inclusion in precision medicine research is important for ethical and scientific reasons. The processes for classifying the populations that enroll in biomedical research, however, are often unclear, inconsistent, and poorly justified. Precision medicine research promises increasingly meticulous approaches to defining research cohorts and assessing the multivariate factors at the root of racial health disparities. Insofar as precision medicine is promoted to members of historically underrepresented populations as a tool for illuminating these factors, the use of race-based classifications is fraught with risks for society and medicine. This article examines the drivers and limitations of the ongoing use of race by investigators juxtaposed with recent efforts to enroll underrepresented populations in precision medicine research.

How Diverse Is Your Universe? An Activity for Students to Reflect on Ethnoracial Diversity During Orientation

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.

Social and Structural Determinants of Urban American Indian and Alaska Native Health: A Case Study in Los Angeles

Introduction

American Indians and Alaska Natives (AIAN) experience significant health inequities, yet there are very few curricula dedicated to training a culturally sensitive workforce to care for this population. There is a further dearth of curricula that center on Indigenous values and ways of knowing.

Methods

We developed a 90-minute interactive workshop aimed at increasing faculty and trainee understanding of the social and structural determinants of urban AIAN health. The workshop consisted of a PowerPoint presentation, two videos, an interactive storytelling exercise, and reflection exercises. Participants also completed pre-/postworkshop questionnaires. The workshop was implemented three times at two medical schools.

Results

There were a total of 35 diverse participants. Regarding the effect of the workshop on participants' knowledge base, a comparison of pre- and postworkshop questionnaire responses showed a statistically significant (p < .05) increase in the correct answer being chosen for each question. All participants agreed or strongly agreed that each of the three learning objectives had been met. Participants particularly valued the workshop's interactive nature, as well as its use of storytelling and multimedia to reinforce policy impact.

Discussion

This workshop provided an interactive and effective method to increase participant knowledge of the importance of a land acknowledgment, of connecting federal Indian policy to health outcomes, and of how AIAN identity may impact access to health care.

Social Justice and Race in the United States: Key Issues and Challenges for Couple and Family Therapy

Social justice tends to be narrowly defined as equality without due recognition of human dignity and respect for those whose daily lives continue to be adversely impacted by race. This article seeks to explore key issues and challenges at the intersection of social justice and race for couple and family therapy. These include: (a) defining social justice; (b) diversity and inclusion; (c) power and privilege; (d) witness; and (e) personal responsibility.

Diversity and Inclusion in the Academic Medicine Workforce: Encouraging Medical Students and Residents to Consider Academic Careers

Introduction

The expansion of medical schools and increased faculty attrition call for heightened efforts to encourage medical students and residents to consider academic careers. As diversity serves as a driver of institutional excellence, special attention to the ongoing underrepresentation of certain groups in academia, such as racial and ethnic minorities, women, and lesbian, gay, bisexual, and transgender individuals, is warranted.

Methods

We developed a 90-minute workshop to raise medical student and resident awareness of academic medicine careers, and the benefits and challenges of having a diverse faculty. The workshop consists of a didactic PowerPoint presentation and a reflection exercise, shared in small- and large-group format, discussing facilitators and barriers to pursuing academia. The workshop was implemented at nine regional conferences.

Results

There were 165 diverse participants. In comparing pre- and postworkshop responses of learners using the sample t test, there was a statistically significant increase in confidence to succeed in academic medicine given learners' gender (2.69 vs. 3.34, p < .001), race and ethnicity (2.53 vs. 3.24, p < .001), or sexual orientation (3.04 vs. 3.42, p < .001). Approximately 95% of learners felt that each of the workshop's learning objectives had been achieved. Participants considered the workshop to be enlightening, motivational, realistic, and validating.

Discussion

This workshop was effective in providing an interactive format for medical students and residents to gain awareness of the state, benefits, and challenges of diversity and inclusion in academic medicine, and can affect their perception of being a future faculty member.

Providing Diverse Trainees an Early and Transparent Introduction to Academic Appointment and Promotion Processes

Introduction

The growth in number of medical schools and increased numbers of faculty tracks have combined with evolving criteria for promotion to trigger a call for greater transparency of academic appointment and promotion processes. Most vulnerable to confusion about these changes are first-generation and diverse medical students and residents, the upstream pipeline of the academic medicine workforce. Diverse medical students have expressed diminished interest in academia because of perceived obstacles in appointment and promotion processes.

Methods

This workshop was designed to utilize didactics and career reflection exercises to help trainees learn: (1) how to define core terms related to academic appointment and promotion processes, (2) how to compare data elements for different CVs and portfolios, (3) common steps in submitting a promotion package, and (4) that they can immediately begin to document content for academic CVs, portfolios, and promotion packages.

Results

One hundred forty-five diverse participants completed an evaluation at eight conferences across the U.S. More than 90% strongly agreed or agreed that the aforementioned objectives were met. Participants commented that the workshop was "illuminating," was "very informative," and "provided an inside look of how faculty are evaluated." Results showed an immediate impact on participants' self-reported confidence to negotiate appointment and promotion processes.

Discussion

Increases in self-rated confidence to negotiate appointment and promotion processes may help sustain trainees' interest in becoming future faculty. Further monitoring will be needed to determine if early exposure to these concepts improves probability of seeking, obtaining, and maintaining appointments.