Knowledge Retention and Clinical Skills Acquisition in Sexual and Gender Minority Health Curricula: A Systematic Review.

PURPOSE: To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD). METHOD: The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees. The final searches were run in March 2019 and rerun before final analyses in June and October 2020. RESULTS: Of 670 full-text articles reviewed, 7 met the inclusion criteria. Five of the 7 studies assessed trainee knowledge retention alone, 1 evaluated clinical skills acquisition alone, and 1 evaluated both outcomes. Studies covered education relevant to transgender health, endocrinology for patients born with DSDs, and HIV primary care. Only 1 study fully mapped to the Association of American Medical Colleges (AAMC) SGM/DSD competency recommendations. Six studies reported institutional funding and development support. No studies described teaching SGM/DSD health care for individuals with multiply minoritized identities or engaging the broader SGM/DSD community in medical education curriculum development and implementation. CONCLUSIONS: Curriculum development in SGM/DSD health care should target knowledge retention and clinical skills acquisition in line with AAMC competency recommendations. Knowledge and skill sets for responsible and equitable care are those that account for structures of power and oppression and cocreate curricula with people who are SGM and/or born with DSDs.

Empiric segmentation of high-risk patients: a structured literature review.

OBJECTIVES: Empiric segmentation is a rapidly growing, learning health system approach that uses large health care system data sets to identify groups of high-risk patients who may benefit from similar interventions. We aimed to review studies that used data-driven approaches to segment high-risk patient populations and describe how their designs and findings can inform health care leaders who are interested in applying similar techniques to their patient populations. STUDY DESIGN: Structured literature review. METHODS: We searched for original research articles published since 2000 that identified high-risk adult patient populations and applied data-driven analyses to segment the population. Two reviewers independently extracted study population source and criteria for high-risk designation, segmentation method, data types included, model selection criteria, and model results from the identified studies. RESULTS: Our search identified 224 articles, 12 of which met criteria for full review. Of these, 8 segmented high-risk patients and 4 segmented diagnoses without assigning patients to unique groups. Studies segmenting patients more often had clinically interpretable results. Common groups were defined by high prevalence of diabetes, cardiovascular disease, psychiatric conditions including substance use disorders, and neurologic disease (eg, stroke). Few studies incorporated patients' functional or social factors. Resulting patient and diagnosis clusters varied in ways closely linked to the model inputs, patient population inclusion criteria, and health care system context. CONCLUSIONS: Empiric segmentation can yield clinically relevant groups of patients with complex medical needs. Segmentation results are context dependent, suggesting the need for careful design and interpretation of segmentation models to ensure that results can inform clinical care and program design in the target setting.