scholarly journals 87. Infectious Disease Diversity, Equity, and Antiracism (ID2EA): A Dedicated Curriculum for Infectious Disease Professionals

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S55-S55
Author(s):  
Shana Gleeson ◽  
Meghan Bathgate ◽  
Jennifer Frederick ◽  
Mahalia S Desruisseaux ◽  
Jaimie Meyer ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Race And Ethnicity ◽  
Medical Training ◽  
Positive Impact ◽  
Racial Microaggressions ◽  
Baseline Survey ◽  
Medical Mistrust ◽  
Structural Racism ◽  
Patient Centered ◽  
Company Stock

Abstract Background Systemic bias in the health care system has adverse effects on health outcomes. Educational programs examining the relationship between structural racism and health inequities are needed to translate knowledge into equitable care. The Yale School of Medicine Infectious Disease (ID) Section designed and piloted an innovative Infectious Disease Diversity, Equity, and Anti-Racism (ID2EA) curriculum to better understand and confront these issues. Methods The ID Section collaborated with pedagogical experts to create a curriculum. A baseline survey of ID faculty and trainees was used to gauge relevant knowledge, attitudes, skills, and topics of interest to participants. The curriculum was designed as a “roadmap” of interactive sessions (“roadmap stops”) focused on topics identified by respondents. Evaluations were performed after events to guide curriculum development and monitor its acceptance and effectiveness. Results All respondents (n=28) to the baseline survey agreed that discussion of race and ethnicity should be integrated into medical training. Most respondents (96%) had experience or knowledge of racial microaggressions in the workplace. Fewer (75%) felt comfortable talking to patients about race and only 68% felt confident teaching learners how to decrease bias in care. The survey identified topics of highest priority to participants, including building trust with patients (75%), providing racially sensitive care (68%) and establishing dialogue with community members (57%). Roadmap stops were constructed based on these priorities, with sessions on race-based medical experimentation and inequities, racial segregation and its impact on health, medical mistrust, and a skill building session on improving patient-centered communication. On follow-up surveys (n=18-28), most participants (93%) saw the sessions as a valuable way to spend time and the majority (91%) reported an impact on their understanding of racism in healthcare; specific changes in thinking were qualitatively coded. Conclusion Our findings demonstrate the positive impact of a curriculum to help understand racism and inequities in medicine. Building and implementing a diversity, inclusion, and anti-racism curriculum in ID sections is feasible, beneficial, and valued. Disclosures Jaimie Meyer, MD, Gilead Sciences (Scientific Research Study Investigator) Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.) Marjorie Golden, MD, Iterum Pharmaceuticals (Consultant)

scholarly journals SARS-CoV-2: Vaccine Hesitancy among Underrepresented Racial and Ethnic Groups with HIV in Miami, Florida

2021 ◽  
Author(s):  
Deborah L Jones ◽  
Ana S Salazar ◽  
Violeta J Rodriguez ◽  
Raymond R Balise ◽  
Claudia Uribe Starita ◽  
...  
Keyword(s):  
Race And Ethnicity ◽  
Cross Sectional Study ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Baseline Survey ◽  
Advisory Group ◽  
Medical Mistrust ◽  
Cross Sectional ◽  
Exact Test ◽  
Novel Coronavirus

Abstract Background SARS-CoV-2 and HIV disproportionally affect underrepresented ethnoracial groups in the US. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. Methods We conducted a cross-sectional study of adults ≥18 years with HIV residing in Miami, FL. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April-August 2020 and followed by a COVID-19 vaccine hesitancy survey from August-November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of Fisher’s exact test Results A total of 94 participants were enrolled, mean age 54.4 years, 52% female, 60% Black non-Latinx, and 40% non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, p=0.009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, p=0.029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, p=0.002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, p=0.049). Conclusion Medical mistrust, vaccine hesitancy and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.

Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making?

2019 ◽  
Vol 38 (4) ◽  
pp. 325-333 ◽  
Author(s):  
Adolfo G. Cuevas ◽  
Kerth O'Brien ◽  
Somnath Saha
Keyword(s):  
Decision Making ◽  
Medical Mistrust ◽  
Patient Centered

scholarly journals The Value of the Oral Medicine Specialty in the Modern Healthcare Systems

2021 ◽  
pp. 1-8
Author(s):  
Mohammed Bindakhil ◽  
Scarlet Charmelo-Silva ◽  
Alhanouf A. Bin Dakhil ◽  
Ibrahim A. ALOmair
Keyword(s):  
Saudi Arabia ◽  
Oral Health ◽  
Medical Training ◽  
Positive Impact ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Medical Community ◽  
Oral Diseases ◽  
Oral Medicine ◽  
Training And Education

<b><i>Background:</i></b> Oral medicine is a subdiscipline of dentistry that concerns itself with the oral health of patients; it focuses on providing diagnosis and management of oral and maxillofacial diseases, as well as direct dental care for those in medically complex situations. As primary healthcare providers, physicians and dentists are often the first to evaluate patients with orofacial symptoms and make diagnoses related to oral health, whether explicit or manifested through systemic diseases. However, a lack of familiarity with oral medicine among healthcare providers often leads to significant delays in the accurate diagnosis and appropriate treatment of many oral and maxillofacial disorders. It has been well established that a lack of training and education in oral health among physicians is an impediment to alleviating the situation. <b><i>Summary:</i></b> Several studies and scientific reports in the medical community have shown a greater professional interest in oral health and medicine, with numerous recent articles reflecting a clear rise in multiple factors: an increased interest in additional training and a rise in oral diseases. This review focuses on the need for a multidisciplinary approach in modern healthcare systems that implements the oral medicine specialty. It also serves to emphasize the role of oral medicine in medical training and education, while simultaneously discussing the prevalence of oral diseases and awareness of oral health among physicians in Saudi Arabia. <b><i>Key Messages:</i></b> The prevalence of oral health conditions in Saudi Arabia appears to be high yet is accompanied by a scarcity of oral medicine specialists in this part of the world. Furthermore, numerous studies have revealed that physicians from different specialties in Saudi Arabia lack training in oral health and possess an insufficient awareness of the oral medicine specialty. This paucity of oral medicine specialists in Saudi Arabia presents a key issue as the clinical services and medical education provided by such specialists in healthcare systems can have a profound positive impact on each patient’s quality of life and health outcomes, as well as the standards of physicians’ training.

scholarly journals The Patient Teacher in General Practice Training: Perspectives of Residents

2018 ◽  
Vol 6 (4) ◽  
pp. 287-295 ◽  
Author(s):  
Marie José Aires ◽  
Rémi Gagnayre ◽  
Olivia Gross ◽  
Cam-Anh Khau ◽  
Sophie Haghighi ◽  
...  
Keyword(s):  
General Practice ◽  
Medical Training ◽  
Teacher Characteristics ◽  
Teacher Participation ◽  
Patient Specific ◽  
First Year ◽  
Patient Centered ◽  
Agreement Rate ◽  
Specific Content ◽  
General Practice Training

Background: Patient teachers were involved in training general practice residents (GPRs) to strengthen the patient-centered approach. They teach a course on health democracy by themselves and teach in tandem with a physician teacher during reflective practice-based classes (named GEPRIs). We present the GPRs’ representations of patient teacher characteristics and capacities and their perception of how useful patient teachers are to their professional development. Methods: We administered a questionnaire based on a preliminary qualitative study to 124 GPRs. It explored (a) changes in the GPRs’ representations about patient teacher characteristics and capacities with regard to teaching over the first year of the experiment; (b) GPRs’ perception of patient teacher utility to their training and their contribution to developing patient perspective–related competencies. Results: The response rate was 89.5% (111/124). The majority of GPRs agreed with 17 (before) and 21 (after) of the 23 patient teacher characteristics and with 17 (before) and 19 (after) of the 20 capacities. The agreement rate increased, overall, after patient teacher participation. The GPRs found patient teacher useful to their training in 9 of 11 topics (agreement rate 65%-92%). They felt they had developed the 14 patient knowledge–related competencies (agreement rate 62%-93%), and 52% to 75% of the GPRs rated the patient teachers’ contribution to those competencies “high or very high,” depending on the competency. Conclusion: This study demonstrates the specific contribution of patient teachers to university-level medical training in France. The GPRs recognized that patient teachers helped them develop competencies by providing patient-specific content.

scholarly journals On Teaching the Sum While Paying Attention to the Parts: Whole Person Care through Ethnography in Medical Education

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Vasiliki Nataly Rahimzadeh ◽  
David Lessard ◽  
Peter Nugus
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
Professional Identity ◽  
Identity Formation ◽  
Medical Training ◽  
Academic Discipline ◽  
Professional Identity Formation ◽  
Patient Centered ◽  
Whole Person

Objective—This article provides a reflection on medical teaching opportunities for whole person care based on our experiences mentoring 2nd-year medical students through an Ethnography Practicum at a Canadian university.                                                                  Background—The Ethnography Practicum is a new addition to the Family Medicine Transition to Clinical Practice (TCP) curriculum introduced in the second year of medical school at McGill University. It involves 30 hours of instruction (6 hours in lectures with an instructor, and 24 hours in small-group tutorials with the authors), and 9 hours of fieldwork observations in various community health settings across Montreal, QC. The primary aims of the Practicum converge with those of the TCP generally in two important ways: to inculcate in students the concepts of patient centered care, and to promote family medicine as both an academic discipline and career option.                    Results and Discussion— Our experiences illustrate two tensions that shape students’ expectations and experiences throughout their involvement in the Practicum and, in turn, highlight the implications for teaching whole-person care. First, ethnography as a combination of different methods has itself been the locus of tensions between positivist and critical traditions in the three last decades. Second, the Practicum is situated precisely at the crossroads of key moments on the professional identity formation continuum for our students. Such a crossroads is disruptive to the status quo of medical traineeship characteristic of the first two years in medical school, and thus reorients professional identity formation. The above tensions reveal how ethnography is not only a revered research tradition in the humanities, but can also be a conduit to whole person care-inspired clinical practice.Conclusion—As instructors and mentors involved in this Ethnography Practicum, we are continually forging a new relevance for organizational ethnography in medical training, where medical students can reflect and act on competencies beyond clinical ones. The Practicum provides a space for students to wrestle with alternative epistemologies to understanding the social world in which medicine is embedded. We lastly provide pragmatic ways to better address these tensions in an effort to support students as they proceed through the (multifaceted) development of their professional identities as future physicians.

scholarly journals Assessment of knowledge, attitude and skills towards e-learning in first year medical students

2019 ◽  
Vol 7 (11) ◽  
pp. 4119 ◽  
Author(s):  
Monali Hiwarkar ◽  
Onjal Taywade
Keyword(s):  
Medical Students ◽  
Medical Training ◽  
Positive Impact ◽  
First Year ◽  
First Year Students ◽  
Learning Modalities ◽  
Conventional Teaching ◽  
Significant Difference ◽  
Education In India ◽  
E Learning

Background: With digitization the e-learning modalities are being increasingly used by medical students. These often help the first MBBS students to overcome limitations of conventional teaching methods like didactic lectures. However, e-learning is not official part of medical education in India and the awareness about its use among medical students need to be evaluated. Aim and objective of the study was to assess the extent to which MBBS first year students use e-resources for learning as well as to assess knowledge, attitude, skills and habits of first MBBS students towards e-learning.Methods: A questionnaire of twenty five questions on various aspects of e-learning was administered to the first MBBS students at two medical colleges. The data generated from responses was compiled and analyzed on SPSS to get insight on various aspects of e-learning.Results: Out of 236 students surveyed 77.97% were aware about the academic websites related to first MBBS subjects. 90.68 % accepted that e-learning helped in understanding topics, 84.32% recommended conventional teaching to be supplemented with e-learning. However there was no statistically significant difference between responses from two groups i.e. female and male students (p>0.05).Conclusions: The majority of first MBBS students use e-resources for learning various topics in anatomy, physiology and biochemistry. The e-resources have made a positive impact on overall learning especially anatomy. e-learning can supplement conventional teaching in the first year of medical training.

scholarly journals Patient-Centered Care: An Examination of Provider–Patient Communication Over Time

2019 ◽  
Vol 6 ◽  
pp. 233339281988287
Author(s):  
Leslie Riggle Miller ◽  
B. Mitchell Peck
Keyword(s):  
Positive Impact ◽  
Patient Centered Care ◽  
Patient Communication ◽  
Self Report ◽  
Primary Data ◽  
Provider Communication ◽  
Patient Centered ◽  
Centered Care ◽  
Over Time

Objective: To examine the quality of provider communication over time considering the increasing emphasis on patient-centered care (PCC). Patient-centered care has been shown to have a positive impact on health outcomes, care experiences, quality-of-life, as well as decreased costs. Given this emphasis, we expect that provider–patient communication has improved over time. Data Source: We collected primary data by self-report surveys between summer 2017 and fall 2018. Study Design: We use a quantitative retrospective cohort study of a national sample of 353 patients who had an ostomy surgery. Data Extraction Method: We measure provider communication from open-ended self-reports from patients of the number of stated inadequacies in their care. Principal Findings: Results show that the time since patients had their surgery is related to higher quality provider communication. That is, patients who had their surgery further back in time reported higher quality provider communication compared with patients who had their surgery performed more recently. Conclusion: Results suggest that the quality of provider communication has not improved even with an emphasis on PCC.

scholarly journals A patient-centred clinical approach to diabetes care assists long-term reduction in HbA1c

2014 ◽  
Vol 6 (3) ◽  
pp. 195 ◽  
Author(s):  
Janet Titchener
Keyword(s):  
General Practitioner ◽  
Diabetes Care ◽  
Positive Impact ◽  
Cost Effective ◽  
Diabetes Mellitus Patient ◽  
Clinical Approach ◽  
Baseline Hba1c ◽  
Patient Centered ◽  
Patient Response ◽  
Specific Patient

INTRODUCTION: Patient-centred care has proven to be cost-effective, with a positive impact on health outcomes. A patient-centred approach is recognised as a desirable component of diabetes care. AIM: The aim of this audit was to determine if the specific patient-centred intervention offered by a clinical service (GPSI Diabetes service) improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). METHODS: The GPSI Diabetes service is a community-based service, run by a general practitioner with a specific interest (GPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their general practitioner (GP) and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their GP. Baseline HbA1c was recorded at intake and for two years after discharge from the service. Patient and GP satisfaction questionnaires were also completed. RESULTS: New Zealand (NZ) Europeans and Maori with Type 2 diabetes and Type 1 diabetes experienced immediate and sustained (two-year) improvements in HbA1c. At intake, baseline HbA1c for Maori was higher than that of NZ Europeans. However, following this patient-centred intervention, this difference was reduced. None of the returned GP or patient questionnaires contained negative feedback, although the patient response rate was low. DISCUSSION: A patient-centred clinical approach to diabetes can contribute to significant and sustained reductions in HbA1c. This clinical approach is potentially reproducible in other clinical settings and could also be applied to the management of other chronic conditions. KEYWORDS: Chronic disease; clinical audit; diabetes mellitus; patient-centered care; self-management

scholarly journals Beyond Antibiotics: A Practical Guide for the Infectious Disease Physician to Treat Opioid Use Disorder in the Setting of Associated Infectious Diseases

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Nikhil Seval ◽  
Ellen Eaton ◽  
Sandra A Springer
Keyword(s):  
Infectious Disease ◽  
Extended Release ◽  
Hospital Admissions ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
Patient Centered ◽  
Infectious Disease Physician ◽  
Centered Care ◽  
Acute Injection

Abstract Infections are a common cause of hospitalization for patients with opioid use disorder (OUD), and hospital admissions are rising in the context of the worsening US opioid crisis. Infectious disease (ID) physicians are frequently the first point of medical contact for these patients. In this article, we discuss the integration of evidence-based management of OUD and patient-centered care of hospitalized persons with acute injection-related infections. We describe the following components of a comprehensive approach for OUD with inpatient ID consultations: (1) how to screen for OUD; (2) how to initiate the 3 US Food and Drug Administration-approved medications for OUD (buprenorphine, methadone, and extended-release naltrexone); (3) how to manage acute pain and opioid-related conditions; and (4) how to link and integrate ID and OUD treatment after hospital discharge. These strategies reduce unplanned discharges and increase completion of recommended antimicrobial regimens.

Early integration of palliative care in Ontario cancer settings.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18234-e18234
Author(s):  
Frances Catriona Wright
Keyword(s):  
Palliative Care ◽  
Positive Impact ◽  
Primary Care Patient ◽  
Life Quality ◽  
Central Nervous System Disease ◽  
Pilot Project ◽  
Care Patient ◽  
Baseline Survey ◽  
Provider Education ◽  
Early Integration

e18234 Background: Introducing palliative care early in the cancer journey results in a better life quality, less aggressive care and possibly longer survival compared to patients receiving standard care. The INTEGRATE project aimed to identify and manage patients who may benefit from palliative care earlier in their cancer treatment. This pilot project assessed whether multidisciplinary forums (Multidisciplinary Cancer Conferences, Clinics and Diagnostic Assessment Programs ) could be used to identify patients using the UK Gold Standards Framework Surprise Question (SQ) “Would you be surprised if this person died within the next year?” Methods: Cancer centres volunteered to pilot test the efficacy of the SQ at multidisciplinary forums and implement a palliative model of care. A survey was completed at 3 different points during the project to measure provider comfort in providing palliative care. All sites received primary level palliative care education. Patient and caregiver experience were assessed using interviews and a validated survey. Identified patients received Advance Care Planning (ACP), symptom management, referrals and standardized reporting to primary care. Patient level data was collected. Results: 3 academic and 1 non-academic cancer centres used the SQ in multidisciplinary forums to identify patients in the Lung, Gastrointestinal and Central Nervous System disease sites between February '15-August '16. A baseline survey showed over 50% of providers had no palliative care training. 157 providers received education and at the end of the project providers had increased comfort & confidence in delivering palliative care. Analyses show that 933 patients were identified using the SQ, from which 78% had ACP initiated and 83% are receiving community palliative care services Conclusions: Multidisciplinary forums appear to be excellent for identifying patients who may benefit from a palliative approach to care. Inter-professional provider education and organized approaches to linking patients to community resources, had a positive impact on provider willingness to address end-of-life and palliative issues. Patients & caregivers report positive experiences of care, but different levels of ‘readiness’ to have the ACP discussions.

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