Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific ...disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence. Approach: A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum. Findings: The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.
Purpose: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of ...dedicated time to explore implicit bias.
Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups.
Results: IATs indicated preferences for "Straight," "White," and "Thin" at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight.
Conclusion: eQuality reduced implicit preference for "Straight" and "White." Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose of this study was to understand medical students’ levels of burnout symptoms and their strategies to combat burnout during the United States Medical Licensure Examination (USMLE) Step 1 ...study period.
We administered a survey to three cohorts of medical students after they had taken the Step 1 examination. We gauged their perceptions on what worked well while studying including any insight into strategies to alleviate burnout. We used a qualitative approach to describe their experiences.
Out of the 477 students surveyed, 370 responded (RR = 77.6%), and we developed 12 key strategies to alleviate burnout during an intense study period: exercise, take days off, limit study hours per day, take breaks, develop support system, dedicate time for fun, eat well, minimize distractors, sleep well, study with others, identify suitable study space(s), and recognize feelings of burnout are normal. We provide further insight into each of these strategies.
By using these strategies, medical students can minimize levels of burnout and maintain wellness throughout the study period. We believe these strategies could be used not only for medical students, but also in the context of any intensive examination preparation period or for a major research paper such as a dissertation. Research has shown that burnout is real and we as researchers and educators must continue to develop strategies to combat it.
Objective
This study aims to estimate the number of hours dedicated to lesbian, gay, bisexual, and transgender content in one medical school’s undergraduate curriculum, compare it to the national ...average, and identify barriers to addressing this content.
Methods
Course and clerkship directors were asked to estimate how many hours they spent on lesbian, gay, bisexual, and transgender content, how many hours would be ideal, and what barriers they perceived to teaching this content.
Results
Faculty members identified lack of instructional time, lack of relevance to their course content, and lack of professional development on this topic as major barriers. There was a significant negative correlation (r
s
=−0.47, p=0.047) between “number of hours dedicated” and “perceived barriers to teaching this content.”
Conclusion
Course and clerkship directors who perceive more barriers to teaching lesbian, gay, bisexual, and transgender content report dedicating less time to its instruction, but the barriers they perceive can largely be mitigated through faculty development.
Impostor phenomenon (IP) is a widely recognized experience in which highly performing individuals do not internalize success. Self-doubt toward one's ability or intelligence is unexpectedly common. ...Prior research has associated IP with medical student perceptions, burnout, and demographic characteristics. However, understanding how student IP experiences are related to actual academic achievement could help medical schools better support student performance and resilience. Hypotheses: The purpose of this research was to examine whether there is a relationship between medical students' USMLE Step 1 scores and experiences of IP. Because medical students receive frequent, objective feedback on exam performance, we hypothesized that students with lower Step 1 scores would experience higher levels of IP. Methods: In 2019, all M1-M4 students at the University of Louisville were invited to complete Clance's (1985) Impostor Phenomenon Scale (CIPS), a previously validated, 20-item, Likert-style scoring instrument designed to reflect respondents' IP experience. We categorized subjects into one of four levels based on CIPS scoring guidelines. For students who had completed Step 1 at the time of the survey, we conducted a Welch's ANOVA test to identify relationships between a student's level of experienced IP and Step 1 scores. We also completed an item analysis comparing individual CIPS item responses with Step 1 performance. Results: Per the CIPS scoring guidelines, we categorized the 233 respondents as experiencing few (10.3%), moderate (47.6%), frequent (31.8%), or intense (10.3%) characteristics of IP. Nearly 90% of our sample experienced at least moderate levels of IP, with over 40% experiencing frequent or intense IP. There were no statistically significant differences among CIPS groups and mean Step 1 scores F (3, 59.8) = 1.81, p = 0.155, and total/inter-quartile Step 1 score ranges broadly overlapped among all four IP experience levels. Within-item response patterns among high and low-scoring students also varied across individual CIPS items. Conclusions: The association between IP experience and Step 1 performance was nonlinear in our cross-sectional sample: the group having the most intense IP experiences did not have the lowest score rank on Step 1, nor did the group with the fewest IP characteristics make up our highest performing group. This, along with the broad dispersion of scores within each of the four IP levels, suggests that students' internalization of achievement and feelings of IP are not consistently aligned with their actual performance on this assessment. Response variation on individual CIPS items suggest that underlying factors may drive variation in IP and performance. These results highlight the need for additional work to identify the constructs of IP that influence medical students specifically so that medical education stakeholders may better understand IP's impact on other facets of medical school and implement the resources necessary to support individuals who experience IP.
Patients who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming (GNC), or born with differences of sex development (DSD) face significant health disparities. Many of these ...disparities originate from discrimination and systemic biases that decrease access to care and from inadequate provider knowledge that contributes to unmet medical needs. Provider training to deliver equitable care for these populations is thus critical, but such training is deficient at most medical institutions. The authors developed an integrated educational model, eQuality, that sought to drive educational and system innovation by teaching and assessing the acquisition of attitudes, knowledge, and skills needed to provide competent care for LGBT/GNC/DSD individuals. This paper outlines the process of its implementation for other programs to model. With input from an LGBT/GNC community advisory panel, eQuality incorporated new teaching sessions and revised existing content in 50.5 h of required curriculum. This curriculum involved 23 teaching faculty and included direct student-LGBT/GNC/DSD patient interactions for 320 students. The program was piloted in the first and second years of medical school and is being expanded into medical school years 3 and 4 with clinical assessments to ensure that curriculum translates into improved patient care. eQuality demonstrates that promoting healthcare equity for LGBT/GNC/DSD populations through medical education is feasible. Forthcoming baseline data will also enable future longitudinal comparisons as eQuality cultivates exceptional insight into the evolution of LGBT/GNC/DSD health knowledge and awareness among both students and faculty.
Background
Professionalism is a key competency in first year medical gross anatomy instruction, yet there is a paucity of longitudinal studies addressing professionalism attributes into year 2. This ...study longitudinally compared 160 preclinical medical students’ peer professionalism evaluations in two small group settings (year 1 anatomy lab and year 2 team-based learning (TBL) sessions) for 2013–2014 and 2014–2015.
Methods
Students were evaluated by their small group peers on a scale (0–3) on five professionalism domains (teamwork, honor/integrity, caring/compassion/communication, respect, responsibility/accountability) at mid-term and end of semester in years 1 and 2. Statistical comparisons were made between the formative (mid-gross) and summative (post-gross) anatomy ratings and between the summative anatomy (post-gross) and mid-term TBL (mid-iTBL) ratings.
Results
Anatomy professionalism evaluations showed a significant increase from an average ranking of 2.49 at mid-term to 2.6 at the end of the semester, with increases in teamwork, honor/integrity, caring/compassion/communication, and respect. Summative anatomy evaluations (post-gross) were compared to mid-term second year TBL (mid-iTBL), showing significant increases in peer professionalism rankings with improvements in teamwork, honor/integrity, responsibility/accountability, and respect.
Conclusions
Significant improvements in peer evaluated professionalism were observed in multiple domains over time in the anatomy lab, with the exception of responsibility and accountability. These gains were maintained into year 2 TBL evaluations, with the exception of caring, compassion, and communication, suggesting that graded peer evaluation may improve professionalism behavior in small group settings.
Obesity is a prevalent disease that is often a source of stigmatization. Weight bias has been documented in healthcare settings and associated with less physician time spent with patients, less ...patient-centered communication, and more patient delay or withdrawal from care. Weight bias is widespread in society and the healthcare field, including among medical students. This study examined the hypothesis that weight bias in medical students is related to negative attitudes toward weight management counseling (WMC), perceived WMC skills, and self-efficacy for WMC. A sample of 762 medical students during their core clerkship rotation (graduating class of 2017) from eight US medical schools completed questions related to weight bias, attitudes toward WMC, perceived WMC skills, and self-efficacy for WMC. Results indicated that medical students with more weight bias held more negative attitudes toward WMC, even after adjustment for age, gender, and intended medical specialty. Weight bias was not significantly related to perceived WMC skills or self-efficacy for WMC. Females had a more positive attitude toward WMC, but lower perceived WMC skills and self-efficacy for WMC than males. Males had significantly more weight bias and were less likely to choose primary care than females. Implications for medical education are discussed.
Abstract Introduction The maldistribution of physicians in the United States has led to a shortage of healthcare providers in rural areas and rural patients being underserved. A physician’s ...connections to rural settings, including upbringing and medical training, often influence the decision to practice in rural areas. This study examines opinions from medical students who participated in a regional rural campus track, which includes summer immersion programs, rural-focused sessions, and clinical rotations. The authors hypothesized that Rural Track students experience urban disruption, and their opinions about rural living and practice would become increasingly less positive over time while students lived at the urban campus for preclinical coursework. Materials and Methods The Rural Health Opinion Survey (RHOS), a previously published measure of opinions concerning living and practicing in rural areas, was administered to students at one public medical school located in Louisville, Kentucky. Factor analysis was performed on each of the three sections of the survey (items related to rural living, patients in rural areas, and physicians in rural areas), and composite subscale scores were calculated for each student. The first phase of this large longitudinal study reported here uses t-tests to compare pre- and post-test scores for 36 students in the Rural Track program. Scores of M1/M2 students who were based at the urban campus were also compared to M3/M4 students who had returned to the rural campus. Results Ninety-two percent (36/39) of Rural Track students completed both pre- and post-surveys, and of these respondents, 89% percent (32/36) grew up in a hometown with fewer than 30,000 people. Overall scores were not significantly different between Rural Track M1/M2 in the urban setting and the Rural Track M3/M4 students based at the rural campus. M3/M4 students showed a differential positive opinion over time of rural comfortable living that approached significance and agreed less that the rural physician workload is heavier. M1/M2 students expressed more positive opinions over time about availability of quality service. Both groups showed strong agreement over time that rural patients are more motivated. Discussion Our hypothesis that Rural Track students on the urban campus would show increasingly less positive opinions about rural health and practice was not supported. Students may not have experienced urban disruption because of the Rural Track curriculum elements, and/or time in the urban environment may have reinforced rural affinity by providing new perspective on the positive aspects of rural settings. Further research and efforts are necessary to identify critical points of reconnection for medical students and to support rural affinity within medical school curriculum. Upcoming research efforts will address the overall hypothesis that Rural Track students’ continued connection to rural settings generates more positive opinions about rural living and practice as compared to opinions from students with rural backgrounds who spend all four years of medical school in the urban setting.
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