Grow502: Centering Community in Medical Education via a Student-Created Organization Focused on Cultivating a Healthy Community.

The COVID-19 pandemic continues to disproportionately impact communities of color and expose health inequities. Minoritized communities experience disparities in chronic diseases, premature death, and cancer, and gaps continue to widen; systemic injustice in housing, nutrition, and environment are major contributors. At the height of the COVID-19 pandemic and racial justice movement, students at the University of Louisville School of Medicine created Grow502 to speak truth to the challenges of health disparities in Louisville, Kentucky. The goal was to pursue a healthier community by raising awareness. Community leaders and health professionals provided expert consultation. This partnership led to the co-creation of a curriculum focused on education, advocacy, community engagement, and creative media. Grow502 sought to support communities impacted by injustices due to racism, limited health literacy, redlining, and limited green space by creating programming centered on education and empowerment. Effective strategies to reduce disparities involve creating interventions with authentic engagement and context. Grow502 involves community stakeholders as active partners. We continue to intentionally seek effective collaborations and interventions that merge our mission and our diverse communities impacted by health disparities.

Perspectives of Transgender and Genderqueer Standardized Patients.

Phenomenon: Disparities in health and healthcare for gender minorities (GMs) such as transgender people are significant, and medical educators have a responsibility to ensure trainees master the clinical skills required to provide them with quality care. We implemented a standardized patient (SP) scenario designed to measure students' ability to provide gender-affirming care and sought to understand the experiences and perceptions of the GMs who served as SPs in this case. Our key research question was: how do GM SPs describe the experience of serving as an SP on a gender-affirming care clinical case? Approach: Semi-structured focus groups were conducted with GM SPs (n = 10) to understand their experiences and gauge their perceptions of portraying a patient seeking gender-affirming care. The patient they portrayed matched their own gender identity. Focus groups were transcribed verbatim and analyzed using inductive thematic analysis. Findings: We developed three primary themes in our analysis: personal connection, gap identification, and insight into medical education. The SPs reported a personal connection to this case, enabling them to give nuanced feedback, confront bias they encountered, and foster connection to their broader community. They were able to identify specific gaps related to communication skills, assumptions, and knowledge about gender identity and gender-affirming care. They gained valuable insight into medical education such as the complexity of learning clinical skills and roadblocks to inclusive simulation. Insights: By sharing the perspectives of GMs in patient simulation, this study demonstrates that GMs can also benefit from engagement with medical education, as the SPs in our study described hope, empowerment, and engagement as positive aspects of participation. This study also shows that GMs' lived experiences seeking medical care were instrumental in their ability to note gaps, which provides valuable insight for other institutions attempting to improve students' GM clinical skills. Further, GM SPs' perspectives are valuable to provide a rationale and guidance to other schools implementing gender-affirming education. Efforts to create and implement gender-affirming care curriculum should include GMs in order to build partnerships and prioritize the voices and agency of GMs.

Association between Characteristics of Impostor Phenomenon in Medical Students and Step 1 Performance.

THEORY: 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.

Experiential Learning: Transforming Theory into Practice through the Parkinson's Disease Buddy Program.

Problem: Persons over age 65 constitute a large proportion of patients presenting for healthcare services; therefore, physicians must be prepared to provide care to patients that face degenerative neurological diseases. Medical students can have difficulty identifying and caring for older patients with neurological difficulties, and often perceive neurology to be a challenging specialty. Medical education service-learning programming that engages community members and medical students, while fostering specialized neurology training, may help improve care for this patient population. Intervention: We developed the Parkinson's Disease Buddy Program for first year medical students (M1s), which involved pairing students with patients with Parkinson's disease (PD) to engage in a social relationship. Students attended monthly seminars covering a range of topics specific to PD patient care and met with their PD buddies throughout the year. A mixed-methods approach was used to evaluate the program and involved pre/post assessments, as well as focus groups with both students and patients. Context: The University of Louisville's School of Medicine and College of Education implemented this volunteer service-learning program for students by partnering with a locally based nonprofit, dedicated to serving PD patients. A total of 70 (35 M1s and 35 PD patients) participated. Outcome: Students' total correct PD knowledge scores significantly increased after participation with a large effect size (pre-test mean = 14.77, [SD = 2.57]; post-test mean = 19.69 [SD = 2.06], Cohen's d = 1.64) and a paired t-test indicated a significant change in students' Parkinson's Attitude Scale scores (t (34) = 2.22, p < .05). Ninety-one percent of students (31) indicated they would recommend the program and 82% (29) indicated they would participate again. During focus groups, students reflected on the relationships they formed with their buddies, indicating the program provided a support system while helping them learn about PD. Patients indicated the program expanded their social circle and meetings with M1s were beneficial. Lessons Learned: An experiential learning opportunity can help medical students become better acquainted with patients living with a neurological disease. We identified an impact on PD patients' self-efficacy and social behavior that was not originally expected. We learned the importance of incorporating active learning modalities such as PD buddy panels and peer-to peer group discussions. The resources required to implement programs like ours can be lightened by engaging with local community partners and collaborating within and outside departments.

Compassion cultivation training promotes medical student wellness and enhanced clinical care.

BACKGROUND: Compassionate health care is associated with positive patient outcomes. Educational interventions for medical students that develop compassion may also increase wellness, decrease burnout, and improve provider-patient relationships. Research on compassion training in medical education is needed to determine how students learn and apply these skills. The authors evaluated an elective course for medical students modeled after the Compassion Cultivation Training course developed by the Stanford Center for Compassion and Altruism Research and Education. The elective goals were to strengthen student compassion, kindness, and wellness through compassion training and mindfulness meditation training modeled by a faculty instructor. The research objectives were to understand students' applications and perceptions of this training. METHODS: Over three years, 45 students participated in the elective at the University of Louisville School of Medicine. The course administered a pre/post Kentucky Inventory of Mindfulness Skills that measured observing, describing, acting with awareness, and accepting without judgment. Qualitative analyses of self-reported experiences were used to assess students' perceptions of compassion training and their application of skills learned through the elective. RESULTS: The mindfulness inventory showed significant improvements in observing (t = 3.62, p = 0.005) and accepting without judgment skills (t = 2.87, p = 0.017) for some elective cohorts. Qualitative data indicated that students across all cohorts found the elective rewarding, and they used mindfulness, meditation, and compassion skills broadly outside the course. Students described how the training helped them address major stressors associated with personal, academic, and clinical responsibilities. Students also reported that the skills strengthened interpersonal interactions, including with patients. CONCLUSIONS: These outcomes illuminate students' attitudes toward compassion training and suggest that among receptive students, a brief, student-focused intervention can be enthusiastically received and positively influence students' compassion toward oneself and others. To underscore the importance of interpersonal and cognitive skills such as compassion and mindfulness, faculty should consider purposefully modeling these skills to students. Modeling compassion cultivation and mindfulness skills in the context of patient interactions may address student empathy erosion more directly than stress management training alone. This pilot study shows compassion training could be an attractive, efficient option to address burnout by simultaneously promoting student wellness and enhanced patient interactions.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives.

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.

Changes in medical student implicit attitudes following a health equity curricular intervention.

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.

A first step in addressing medical education Curriculum gaps in lesbian-, gay-, bisexual-, and transgender-related content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program.

BACKGROUND: Individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, and/or born with differences of sex development have specific health needs and significant health disparities exacerbated by a lack of training among health professionals. The University of Louisville LGBT Health Certificate Program used an interdisciplinary approach to increase training, potentially enabling future physicians to provide quality healthcare to LGBT patients. METHODS: A pretest-post-test design was used to investigate medical students' (n = 39) attitude and knowledge outcomes after program participation. Attitudinal items with Likert-type responses were analyzed using the Wilcoxon signed-rank test. Baseline frequency and percentage of correct responses were tabulated for knowledge questions. At both pre- and post-test, the 11 knowledge items were summed to establish a total knowledge score, creating two total scores. The paired sample t-test was used to evaluate the pre- and post-change, and Cohen's D was used to assess effect size. All P values were two-tailed. Statistical significance was set by convention at P < 0.05. RESULTS: Students correctly answered 69% or less of the knowledge questions at baseline. Total correct knowledge scores significantly increased post intervention with the effect size being large (Cohen's D = 0.90, P < 0.001). Attitudes significantly increased post intervention on two items (P = 0.019 and P = 0.037). Some attitude items decreased post intervention: students felt it is more challenging to conduct a patient history with a LGB patient (pre-mean agreement = 2.44; post-mean agreement = 2.97, P = 0.018). CONCLUSIONS: Medical educators can play a critical role in decreasing LGBT healthcare disparities. The University of Louisville LGBT Health Certificate Program played an important first step in increasing medical students' knowledge and improving certain attitudes about LGBT patients.

Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study.

BACKGROUND: Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery. METHODS: Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region. RESULTS: Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system. CONCLUSION: Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.

Concurrent validation of CHIRP, a new instrument for measuring healthcare student attitudes towards interdisciplinary teamwork.

Positive attitudes towards teamwork among health care professionals are critical to patient safety. The purpose of this study is to describe the development and concurrent validation of a new instrument to measure attitudes towards healthcare teamwork that is generalizable across various populations of healthcare students. The Collaborative Healthcare Interdisciplinary Planning (CHIRP) scale was validated against the Readiness for Inter-Professional Learning Scale (RIPLS). Analyses included student (n = 266) demographics, ANOVA, internal consistency, factor analysis, and Rasch analysis. The two instruments correlated at r = .582. The CHIRP showed a multifactorial structure having excellent internal consistency (alpha = .850), with 25 of the 36 scale items loading onto a single Teamwork Attitudes factor. The RIPLS likewise had strong internal consistency (alpha = .796) and a three-factor structure, supporting previous studies of the instrument. However, Rasch analyses showed 14 (38.9%) of the 36 CHIRP items, but only four (21.1%) of the 19 RIPLS items remaining within the satisfactory standardized OUTFIT zone of 2.0 standard deviation units. We propose the 14 fitting items as a new, validated teamwork attitudes scale.

Integrating Cultural Awareness into Medical Gross Anatomy Instruction.

Medical students need to understand how culture and patient management relate in order to provide optimal care to a diverse society. Multiple studies call for more cultural training in medical education. Some studies show that well-intentioned cultural competency curriculum can reinforce stereotypes, yet it is essential for educators to discuss varying identities with our students in their training in order to avoid the implication that white is the default patient identity. Our study evaluates a pilot, novel approach for integrating cultural content into the biomedical sciences, specifically gross anatomy. Clinical vignette practice questions were developed as tools to help students expand their anatomical knowledge and cultural and socioeconomic awareness, taking special consideration to avoid stereotypical presentations. We evaluated class of 2021 students' self-reported cultural awareness and ability to utilize culturally relevant information through completion of a survey in fall 2017 (pre) and winter 2017 (post). The students were surveyed on their ability to recognize and/or integrate culturally relevant information. Twenty-one students (n = 21) participated. There was significant improvement in the overall cultural awareness score between the pre- and post-surveys (pre mean = 3.54, while post mean = 3.81; p = 0.016). The most dramatic domains that students became aware of included incorporating culturally relevant information into a treatment plan and communicating with sensitivity and respect when caring for patients. Culturally informed curriculum does not need to be limited to the humanities courses in medical education. Direct integration into biomedical sciences is a novel approach to help students gain exposure to biomedical and cultural content simultaneously.

Griev_Ing: death notification skills and applications for fourth-year medical students.

BACKGROUND AND PURPOSE: Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance. METHODS: GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills. ANCOVA was performed, with gender and race covariates. RESULTS: All groups improved on death notification competence and confidence at about the same rate. Competence significantly (p =.037) improved for the feedback group. Interpersonal communication scores declined for all groups. CONCLUSIONS: GRIEV_ING provides an effective model medical educators can use to train medical students to provide competent death notifications. Senior medical students are primed to learn death notification and do not require a preexposure.

Interprofessional LGBT Health Equity Education for Early Learners.

INTRODUCTION: The eQuality project at the University of Louisville aims to train future physicians to deliver equitable quality care for all people by creating an integrated educational model utilizing the competencies identified in the AAMC's Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD. This foundational interprofessional health equity session for early learners addresses knowledge and attitude milestones relating to interprofessional collaboration, professionalism, and systems-based practice competencies for lesbian, gay, bisexual, and transgender (LGBT) populations. METHODS: First-year medical students were assigned to interprofessional teams of approximately 10 health sciences students each. Students participated in a 75-minute session utilizing a group case study activity, including a systems lecture exploring social determinants and community resources related to LGBT health. Students collaboratively discussed the case and recorded strategies for optimal patient care. The Readiness for Interprofessional Learning Scale and health disparities attitudes and knowledge scales were administered pre-/postsession. RESULTS: One hundred fifty-eight first-year medical students participated in the session. Posttest scores reflected an improvement for all disparities knowledge items (p < .001), and an increased interest in working with other health professions students on future projects (p < .001). Changes in attitudes toward systemic and social factors affecting health were also observed. However, content analysis of worksheets revealed that only 36% of teams identified specific action steps for the case scenarios. DISCUSSION: This session was effective in improving knowledge and attitudes related to LGBT health equity and interprofessional education.

Improving medical graduates' training in palliative care: advancing education and practice.

The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.

Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration.

OBJECTIVES: The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. METHODS: The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N = 438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). RESULTS: All four cohorts demonstrated an improvement in attitudes (F(1,370) = 48.7, p = 0.001) and knowledge (F(1,353) = 87.3, p = 0.001) pre- to post-test. No educational modality appeared superior for attitude (F(3,370) = 0.325, p = 0.808) or knowledge (F(3,353) = 0.382, p = 0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F(3,18) = 2.12, p = 0.134). CONCLUSIONS: Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Teaching culturally appropriate care: a review of educational models and methods.

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.