62-year-old woman • dysuria • dyspareunia • urinary incontinence • Dx?

► Dysuria ►Dyspareunia ► Urinary incontinence.

Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020.

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race-ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010-2020) electronic database to identify most recently published national estimates by race-ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial-ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.

Morehouse School of Medicine Case Study: Teacher-Learner Relationships Free of Bias and Discrimination.

Bias can impact all aspects of human interactions and have major impacts on the education and evaluation of health care professionals. Health care and health professions education, being very dependent on interpersonal interactions and learning as well as on the assessment of interpersonal behaviors and skills, are particularly susceptible to the positive and negative effects of bias. Even trained and experienced evaluators can be affected by biases based on appearance, attractiveness, charm, accent, speech impediment, and other factors that should not play a role in the assessment of a skill. At the Morehouse School of Medicine, elements in the curriculum and the milieu help decrease the burden of bias experienced by learners. In addition, many of the learners develop knowledge, skills, and attitudes that appear to assist them with navigating bias in other learning or practice environments. In this case study, the authors reflect on these elements and how they can be replicated in other settings. According to the authors, modifying the learning environment to enhance and sustain relationships is key in addressing toxic bias.

The Diversity and Success of Medical School Applicants With Scores in the Middle Third of the MCAT Score Scale.

Admissions officers assemble classes of medical students with different backgrounds and experiences who can contribute to their institutions' service, leadership, and research goals. While schools' local interests vary, they share a common goal: meeting the health needs of an increasingly diverse population. Despite the well-known benefits of diversity, the physician workforce does not yet reflect the nation's diversity by socioeconomic status, race/ethnicity, or other background characteristics.The authors reviewed the Medical College Admission Test (MCAT) scores and backgrounds of 2017 applicants, accepted applicants, and matriculants to U.S. MD-granting schools to explore avenues for increasing medical school class diversity. They found that schools that accepted more applicants with midrange MCAT scores had more diverse matriculating classes. Many schools admitting the most applicants with scores in the middle of the MCAT score scale were public, community-based, and primary care-focused institutions; those admitting the fewest of these applicants tended to be research-focused institutions and to report pressure to accept applicants with high MCAT scores to maintain or improve their national rankings.The authors argue that reexamining the use of MCAT scores in admissions provides an opportunity to diversify the physician workforce. Despite evidence that most students with midrange MCAT scores succeed in medical school, there is a tendency to overlook these applicants in favor of those with higher scores. To improve the health of all, the authors call for admitting more students with midrange MCAT scores and studying the learning environments that enable students with a wide range of MCAT scores to thrive.

Shifting the Curve: Fostering Academic Success in a Diverse Student Body.

PROBLEM: Diversity in the health care workforce is key to achieving health equity. Although U.S. medical schools have worked to increase the matriculation and academic success of underrepresented minority (URM) students (African Americans, Latinos, others), they have had only limited success. Lower standardized test scores, including on the Medical College Admission Test (MCAT), have been a barrier to matriculation for many URM applicants. Lower subsequent standardized exam scores, including on the United States Medical Licensing Exam Step 1, also have been an impediment to students' progress, with mean scores for URM students lagging behind those for others. APPROACH: Faculty at the Morehouse School of Medicine developed and implemented interventions to enhance the academic success of their URM students (about 75% are African American, and 5% are from other URM groups). To assess the outcomes of this work, the authors analyzed the MCAT scores and subsequent Step 1 scores of students in the graduating classes of 2009-2014. They also reviewed course evaluations, Graduation Questionnaires, and student and faculty interviews and focus groups. OUTCOMES: Students' Step 1 scores exceeded those expected based on their MCAT scores. This success was due to three key elements: (1) milieu and mentoring, (2) structure and content of the curriculum, and (3) monitoring. NEXT STEPS: A series of mixed-method studies are planned to better discern the core elements of faculty-student relationships that are key to students' success. Lower test scores are not a fixed attribute; with the elements described, success is attainable for all students.

Racial and ethnic disparities in infant and maternal mortality.

Despite marked improvements in lowering infant and maternal mortality rates, certain racial and ethnic groups have benefited less. The reasons for these inequalities are many and complex. This article reviews the literature to assess the extent and reasons for the disparate outcomes in infant and maternal mortality rates among different racial and ethnic groups in the United States. Some strategies aimed at reducing these disparities are also highlighted. A systematic search of OVID-MEDLINE (1970-2005) electronic databases was conducted. This review, which contains data mostly on Black/White disparities, suggests that infant and maternal mortality rates differ among racial and ethnic groups. Potential strategies to ameliorate these differences include continued funding for community health centers, equitable and timely access to health care, and training of more minority physicians. In addition, continued research on the role of stress in preterm delivery among some minority women is important in any effort to lower these disparities.

Racial disparities in reproductive health outcomes.

Racial and ethnic disparities exist in many areas of health care, but the magnitudes of these disparities vary and are not fully understood. In women's health care, disparities in reproductive health outcomes are quite common. In this article, a review was performed to assess the magnitude and reasons for some of the most common disparate reproductive health outcomes, such as infant and maternal mortality, unintended pregnancies, and preventive care. Papers were retrieved by systematically searching OVID-MEDLINE (1966-2002) electronic databases and hand-searching relevant reference lists and bibliographies. Those findings are reviewed here, and some interventions to move toward a reduction of these disparities are suggested. Our review, which contained mostly data on black-white differences, suggest that large disparities continue to exist in many reproductive health outcomes and that collaborative efforts at multiple levels in the community and health care system are needed if we are to effectively close the gaps.