Characterizing Autonomy Supportiveness in Diabetes Peer Health Coaches

BackgroundPrior studies have shown that peer health coaching improves outcomes among adults with chronic conditions such as diabetes. These studies have also suggested that higher ratings of their peer coach’s autonomy supportiveness, i.e., the degree to which a coach supports participant choice, is associated with improved outcomes. The types of actual behaviors and interactions that participants in these coaching relationships perceive as being more or less autonomy supportive are important to define. This investigation aims to more concretely characterize the ways in which participants perceive autonomy support and how important these perceptions are to their satisfaction with their peer coaches.MethodsThis article is a qualitative investigation of the US Department of Veterans Affairs–Technology Enhanced Coaching (VA-TEC) study, a parallel randomized controlled trial with diabetes patients with poor glycemic control at the Detroit VA Medical Center. Intervention arm participants work for 6 months with peer coaches who are also VA patients who now have good glycemic control. Researchers conducted semi-structured interviews with veterans who had recently completed their 6 months of coaching. Responses to Health Care Climate Questionnaire (HCCQ) items in the trial’s 6-month survey were used to identify veterans for interviews who rated their coaches either especially high or low in terms of autonomy supportiveness. Interview responses were then analyzed in order to elucidate veterans’ perceptions of autonomy support in their coaching relationships.ResultsSemi-structured interviews were conducted with 17 of the veterans who completed the VA-TEC program. Veterans who rated their coaches higher on HCCQ items tended to emphasize the positivity and non-judgmental nature of their coaches. They also described coaches who offered them choices and non-directive suggestions in identifying health behavior goals. Veterans who gave their coaches lower HCCQ ratings described coaches who tended to be less personally engaged and less focused on addressing veterans’ specific concerns about diabetes. Some veterans who rated their coaches lower on autonomy-supportiveness felt their coaches underestimated their existing knowledge of diabetes and were overly directive in providing advice. Overall, participants’ HCCQ ratings correlated well with expressed satisfaction with their coach in interviews. ConclusionsVA-TEC participant feedback outlines meaningful ways in which coaches can support autonomy. These include, among others, eliciting participants’ personal goals, remaining positive and non-judgmental, providing suggestions for behavior changes without being overly directive, and maintaining a balance between discussing diabetes and the types of personal conversations that are crucial to building trust. The effective behaviors described in this investigation can be used to train future coaches and other lay health workers.

Prescription Stimulant-Induced Neurotoxicity: Mechanisms, outcomes, and relevance to ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a relatively prevalent neuropsychiatric and neurodevelopmental condition characterized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ) as difficulty sustaining attention and maintaining tasks at hand, heightened distractibility, and other deficits in executive functioning. Prescription stimulants—amphetamine (AMP) and methylphenidate (MPH)—are the first-line treatment(s) for ADHD in both pediatric and adult populations and exist in many formulations. Troublingly, the non-medical use (NMU) of amphetamine and methylphenidate is more prevalent in the American population, especially on college and university campuses, than the condition of interest. The neurotoxicological profile and NMU epidemiology of prescription stimulants is of direct relevance to primary care physicians and psychiatrists as they are the providers most frequently tasked with the treatment of ADHD and the surveillance of substance misuse behaviors in the young adult population. As comprehensive literature reviews of the mechanisms and potential adverse sequelae of prescription stimulant-induced neurotoxicity intended for medical clinicians have been quite sparse in the last decade—especially given the gravity of the issue—this article includes a brief primer on ADHD etiology and pathophysiology; considers the current state of NMU epidemiology; reviews the mechanisms of action of AMP and MPH; and, finally, summarizes known molecular and clinical manifestations of AMP and MPH neurotoxicity.

Pimping: Valuable Teaching Tool or Mistreatment? Perceptions of Medical Students and Faculty Differ.

ImportanceThe AAMC Graduate Questionnaire has drawn attention to medical student mistreatment. Pimping, a form of Socratic teaching often used in medical education where students are singled out by faculty for questioning, may be considered by some students and faculty as mistreatment. To date, minimal research has been performed on the viewpoints of students and faculty regarding pimping and its relation to mistreatment. ObjectiveThis study aims to formally define pimping and determine if there is a difference in the perception of students and faculty on its role in medical education.Design: Medical students and faculty of Michigan medical schools were surveyed via electronic questionnaire. Chi-squared and Fisher’s exact tests were performed.SettingMedical schools within the state of Michigan ParticipantsStudents who had completed their core clerkships and faculty with experience educating medical students in a clinical setting ResultsThe student response rate was 42%; the faculty response rate could not be determined. The majority of students agreed with our operational definition of pimping and 100% had experienced pimping. 54% of students reported a positive experience with pimping, 26% neutral, and 20% reported a negative experience. The majority of students reported it was challenging and educational and should be used regularly. Several differences were found between students and faculty as to why faculty use pimping. Students’ perception of their role on the clinical care team influenced their perception of pimping as mistreatment, and students reported pimping made them feel more a part of the team.Conclusion and relevanceThis study helps to define pimping and sheds more light on the perceptions of pimping from students and faculty and their differences. Most medical students report a benefit from pimping, even though it may be stressful, and suggest it should be used regularly, which is in contrast to faculty opinion. Pimping may make students feel more a part of the clinical care team, but their role on the team may not influence whether they perceive it as mistreatment.  Our data suggest medical schools should educate students and faculty on pimping and not move toward discouraging or banning it.

Patient Knowledge of Opioid Usage and Side Effects Prior to Surgery

BackgroundGiven the increasing morbidity and mortality related to prescription opioids in the United States, it is critical for patients to understand the risks and proper usage of opioid analgesics.MethodsWe surveyed 166 patients undergoing elective surgery at a single tertiary care facility preoperatively. We queried patients regarding aspects of prescription opioid use, side effects and adverse effects, and storage and disposal behaviors.ResultsOverall knowledge regarding prescription opioids was high (mean score = 8.05/12, range 0–12). The average number of questions answered correctly was not significantly different based on opioid use at the time of the survey (65% vs 67.5%, p = 0.52). Characteristics significantly associated with higher knowledge included young age (p = 0.01), female gender (p < 0.01), and white race (p = 0.01).ConclusionsPatient knowledge regarding prescription opioids is high preceding surgery, but gaps remain regarding side effects and adverse effects. Knowledge did not differ by prior or current opioid use, and these findings may help target important knowledge gaps to improve patient education regarding opioids during the preoperative period.

The Patient History Project: Medical Student Innovation in Improving Medical Care for Asylum Applicants

BackgroundPersons who experienced persecution in their home country may apply for asylum with the United States. This population has complex medical needs complicated by cultural and linguistic barriers. This report outlines the design and evaluation of the Patient History Project (PHxP), a collaborative program between the University of Michigan Asylum Collaborative (UMAC) and a local non-profit, Freedom House Detroit (FHD), to improve the quality of health care for asylum-seekers while training medical students to work with vulnerable populations.MethodsIn the PHxP, medical students trained by UMAC interviewed FHD residents and created electronic medical records that residents could share with subsequent medical providers. These sessions additionally provided an opportunity for asylum-seekers to rehearse health care utilization in the comfort of their home. Surveys of students and asylum-seekers, and a semi-structured interview with FHD staff, were conducted to evaluate the program’s performance on multiple dimensions.ResultsAsylum-seekers reported high levels of overall satisfaction with PHxP and increased confidence in the health care setting. Medical student volunteers reported gaining cultural sensitivity and clinical skills. FHD staff noted greater insight into resident medical needs.ConclusionsAs the number of asylum-seekers in the United States continues to rise, so will the need of specialized services including medical care. This program is one strategy to help address the medical needs of asylum-seekers. Medical schools with programs to provide forensic medical exams and affidavits for asylum-seekers would be particularly well situated for the trial of such a program.

Well-Being and General Anxiety Among University of Michigan Dental Students

BackgroundAnxiety is one of the most prevalent mental health conditions, affecting approximately 1 in 9 people worldwide. More specifically, dental students have been considered vulnerable to anxiety despite the fact that dental students have also reported high levels of well-being. Therefore, we hypothesize that University of Michigan School of Dentistry (UMSOD) dental students pose high levels of well-being but suffer from anxiety. Our objective is to measure anxiety and well-being levels among UMSOD dental students for 2 consecutive academic years.MethodsDental students (N = 609) were surveyed for well-being and general anxiety levels. To assess well-being and anxiety levels we used the World Health Organization–Five Well-Being Index (WHO-5) questionnaire and the General Anxiety Disorder 7-item (GAD-7) scale, respectively. Surveys were sent through Qualtrics. For statistical analysis, chi-square and t test were used at p < 0.05.ResultsThe mean well-being score among dental students was 12.26 (SD = 1.14). In the first survey moment for anxiety, which coincided with the week before the spring break in 2017, approximately 39% of the respondents (n = 255) scored 10 or higher on the GAD-7, which means moderate anxiety. In the second survey moment, the week after the spring break week in 2017, we found a slight but not significant reduction in anxiety levels, with approximately 32% of the responses (n = 109) of the dental students scoring 10 or higher on the GAD-7. Incoming first-year dental students before starting the dental school program presented well-being mean of 18 (SD = 0.60). Only 13% of incoming first-year dental students scored 10 or higher on anxiety before starting the school program. By the fall term, the well-being mean among incoming first-year dental students dropped to 13.29 (SD = 1.32), and 22% of the incoming first-year dental students scored 10 or higher in the GAD-7.ConclusionsUniversity of Michigan School of Dentistry dental students posed poor well-being and moderate anxiety. Incoming first-year dental students posed higher well-being and lower anxiety levels before starting the dental education program. However, as the academic year developed, incoming first-year dental students suffered a decrease in well-being and an increase in anxiety levels. Our study indicates a trend of poor well-being and high anxiety among UMSOD dental students.