Urology HEIRS: A Feasibility and Acceptability Study for Video-Based Research on Physician-Family Communication in Pediatric Urology Visits.

PURPOSE: Patient- and family-centered communication is essential to health care equity. However, less is known about how urologists implement evidence-based communication and dynamics involved in caring for diverse pediatric patients and caregivers. We sought to evaluate the feasibility and acceptability using video-based research to characterize physician-family communication in pediatric urology. MATERIALS AND METHODS: We assembled a multidisciplinary team to conduct a multiphase learning health systems project and establish the Urology HEIRS (Health Experiences and Interactions in Real-Time Studies) corpus for research and interventions. This paper reports the first phase, evaluating feasibility and acceptability based on consent rate, patient diversity, and qualitative identification of verbal and paraverbal features of physician-family communication. We used applied conversation analysis methodology to identify salient practices across 8 pediatric urologists. RESULTS: We recruited 111 families at 2 clinic sites; of these 82 families (N = 85 patients, ages 0-20 years) participated in the study with a consent rate of 73.9%. The racial/ethnic composition of the sample was 45.9% non-Hispanic White, 30.6% any race of Hispanic origin, 16.5% non-Hispanic Black/African American, 4.7% any ethnicity of Asian/Asian American, and 2.3% some other race/ethnicity; 24.7% of families used interpreters. We identified 11 verbal and paraverbal communication practices that impacted physician-family dynamics, including unique challenges with technology-mediated interpreters. CONCLUSIONS: Video-based research is feasible and acceptable with diverse families in pediatric urology settings. The Urology HEIRS corpus will enable future systematic studies of physician-family communication in pediatric urology and provides an empirical basis for specialty-specific training in patient- and family-centered communication.

Leveraging Resident-As-Teacher Training for Health Equity Education: A Transformative Approach.

Issue: Resident teachers play an essential role in medical education and can support broader efforts to advance anti-racism and health equity in medicine. The Accreditation Council for Graduate Medical Education requires programs to provide education about health care disparities so residents can contribute to and lead work in this area. However, the literature includes few examples, frameworks, or strategies for preparing residents to develop the knowledge and skills needed to promote health equity, including in their role as clinical teachers. Evidence: In this article, the authors propose leveraging Resident-as-Teacher training to support residents in learning and teaching for health equity. Gorski's conceptualization of equity literacy provides an evidence-based framework for four main abilities (recognizing, responding, redressing, and cultivating/sustaining) residents and medical students can develop through co-learning about health equity in the clinical learning environment. The authors discuss preconditions, example activities, and assessments strategies for effective health equity education. Based on the principles of social learning theory, the authors recommend that Resident-as-Teacher training be part of an institutional strategy to cultivate a community of practice for health equity education. Implications: Incorporating health equity education into Resident-as-Teacher curriculum offers a potentially transformative part of the broader strategy needed to prepare the next generation of physicians to enact anti-racism and advance health equity.

Questions to promote child-centered care in racially discordant interactions in pediatric oncology.

OBJECTIVE: To examine questioning practices in racially discordant interactions and describe how these practices engendered child-centered care. METHODS: We used applied conversation analysis to analyze a collection of 300 questions directed to children across 10 cases involving children of color and their families in disease reevaluation appointments in pediatric oncology. RESULTS: Our analysis generated two patterns: 1) both the pediatric oncologists' and caregivers built upon one another's talk to enable the child's conversational turn, and 2) the oncologists' reformulated requests as questions to invite the child's permission and cooperation for completing exams and understanding symptoms. CONCLUSION: Children, pediatric oncologists, and caregivers coordinated their actions to enable children to participate as recipients of and respondents to questions. The analysis of real-time interactions illuminates practices for centering children in clinical encounters and the benefits of doing so. PRACTICAL IMPLICATIONS: This study's findings have implications for defining competencies and practices for fostering child-centered communication, creating training materials based on real-time encounters, and identifying strategies for humanizing pediatric patient experiences.

Facilitators and Barriers to the Adoption of Holistic Practices for Inclusive Recruitment in Graduate Medical Education.

OBJECTIVE: A diverse physician workforce ensures equitable care. The holistic review of residency applications is one strategy to enhance physician diversity; however, little is known about current adoption and the factors that facilitate/impede the adoption of holistic recruitment practices (HRPs) by graduate medical education (GME) residency, and fellowship program directors (PDs). To describe the current state and explore, the barriers/facilitators to the adoption of HRPs at our institution. METHODS: We disseminated information about HRP within our program between 2021 and 2022. In May 2022, a survey of 73 GME PDs assessed current recruitment practices and self-reported barriers to holistic recruitment. Holistic Recruitment Scores (HRSs) reflecting the adoption of best practices were tabulated for each program and compared to identify predictors of adoption. RESULTS: 73/80 (92%) of PDs completed the survey. Programs whose PDs had higher academic rank, total number of trainees, and female trainees in the past 3 years had higher HRSs. Program size was directly correlated with HRS. Most (93%) PDs felt their current efforts were aligned to increase diversity and 58% felt there were no barriers to the adoption of holistic review. The most reported barriers were lack of time and knowledge/expertise in diversity, equity, and inclusion (DEI), both reported by 16 out of 73 PDs (22%). CONCLUSION: While most PDs implemented some HRP, institutional and departmental support of program directors through the commitment of resources (eg, staffing help and subject matter experts/coaches hiring) are crucial to overcome barriers.

Well-being amongst undergraduate students during the dual pandemic: an exploratory study.

Background: The COVID-19 pandemic significantly impacted the college experience. Concurrently, social justice movements highlighting systemic racism and police brutality were taking place.We explored the extent to which undergraduate students from a private university felt both positive and negative emotions due to the dual pandemic. Methods:Undergraduate students reported the extent to which they felt 19 emotions due to COVID-19 in August 2020 (n = 944) and January 2021 (n = 321). In August 2020, participants also indicated the extent to which they felt the same emotions due to the civil unrest occurring in response to systemic racism and police brutality. Results: Participants felt a wide range of emotions in response to the dual pandemic. Students felt more positively about the civil unrest compared to COVID-19 in August 2020. Despite vaccine availability, negative emotions regarding COVID-19 rose in January 2021. Conclusions: The implications of the ongoing effects of the dual pandemic are discussed.

Barriers and Facilitators of Health and Well-Being in Informal Caregivers of Dementia Patients: A Qualitative Study.

BACKGROUND: Given the dramatic projected increase in Alzheimer's disease globally and the increased risk of morbidity and mortality for family caregivers of these patients, there is an urgent need to provide more targeted, timely resources to support the health and well-being of these informal caregivers. Few studies have investigated the barriers to health and well-being and potential strategies to facilitate better self-care from the unique perspective of the caregivers themselves. PURPOSE: This qualitative study aimed to identify barriers and facilitators to health and well-being for informal caregivers of family members with Alzheimer's. METHOD: We conducted semi-structured interviews with eight informal caregivers, including daughters, wives, and one husband, ages 32 to 83. Using Reflexive Thematic Analysis, we identified three main themes and subthemes across caregivers' experiences. FINDINGS: We found that caregivers (1) prioritized mental and social well-being over physical health or health behaviors; (2) characterized the subjective burden of caregiving as a "mantle of responsibility" that could not easily be shed due to the complex subjective burden of loss, grief, guilt, resentment, isolation, loneliness, and lack of agency; (3) sought to be recognized as "additional patients", instead of being viewed as invisible patients, with support services tailored to their life stage and challenges. CONCLUSIONS: The findings suggest that the subjective burden of strain experienced by family caregivers of Alzheimer's patients has a profound impact on their health and well-being, even more so than the objective burden of strain that is the result of their day-to-day caregiving activities.

Advancing Equity in Graduate Medical Education Recruitment Through a Diversity Equity and Inclusion (DEI) Toolkit for Program Directors.

Objectives: To increase diversity and inclusion in graduate medical education (GME), the Accreditation Council for Graduate Medical Education (ACGME) issued new diversity standards requiring programs to engage in practices that focus on systematic recruitment and retention of a diverse workforce of trainees and faculty. The literature on how program directors (PDs) can incorporate and prepare for this standard is limited. Methods: We developed a diversity, equity, and inclusion (DEI) toolkit for PDs as an example of an institutional GME-led effort to promote inclusive recruitment and DEI awareness among residency and fellowship programs at a large academic center. Results: A survey was sent to 80 PDs before the launch of the toolkit and 6 months afterwards with response rates of 27% (22/80) and 97% (78/80), respectively. At baseline, 45% (10/22) anticipated that the DEI toolkit might provide better resources than those currently available to them and 41% (9/22) perceived that the toolkit might improve recruitment outcomes. At 6 months, 63% (49/78) found the toolkit helpful in the 2021-2022 recruitment season. By contrast, 2% (2/78) of PDs did not find the toolkit helpful, and 33% (26/78) said they did not access the toolkit. When asked if a PD changed their program's recruitment practices because of the toolkit, 31% (24/78) responded yes. Programs that changed recruitment practices started to require unconscious bias training for all faculty and residents involved in the residency interviews and ranking. Others worked on creating a standardized scoring rubric for interviews focused on four main domains: Experiences, Attributes, Competencies, and Academic Metrics. Conclusion: There is a need to support PDs in their DEI journey and their work to recruit a diverse workforce in medicine. Utilizing a DEI toolkit is one option to increase DEI knowledge, skills, awareness, and self-efficacy among PDs and can be adopted by other institutions and leaders in academic medicine.

Understanding the Experiences of Black Women Medical Students and Residents: A Narrative Review.

Background: Few research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women's experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education. Methods: Using Crenshaw's intersectionality as an analytical tool, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education. Results: The results generated 13 citations specifically discussing Black women medical students and residents, with only six studies being empirical research. Conclusion: We conclude that 13 articles is inadequate for understanding the experiences of these populations. Without centering Black women or using an intersectional lens, researchers could invalidate the lived experiences of this population and create barriers to the political resources Black women learners need to be successful. Moreover, the lack of intention behind addressing the needs of Black women can be viewed as complicity in the oppressive structures that serve to subjugate them.

Serving on a Graduate Medical Education Diversity, Equity, Inclusion, and Justice Committee: Lessons Learned From a Journey of Growth and Healing.

Efforts toward achieving diversity, equity, inclusion, and justice (DEIJ) within graduate medical education (GME) often begin with the formation of a DEIJ committee that steers the work. Little is known about the experiences and the challenges faced by those serving on such committees. We sought to describe the experiences of members of our institutional GME DEIJ committee to gain knowledge that would propel this work forward. An open-ended survey was electronically administered to members of our institutional GME DEIJ committee. Responses were analyzed using a rapid qualitative analytical approach. Eighteen members (58%) responded. Of these, (67%) were women and five (28%) were Black. Six domains emerged: "motivation," "challenges," "emotional response," "highs," "facilitators," and "advice." Black respondents more often cited the need to increase diversity as a motivator to join this work. Women and Black respondents more often identified time constraints as a challenge to participation. Some members found the work emotionally draining; others described it as uplifting. Two themes emerged as high points of participation-pride and achievement around the work completed and the personal benefits of building a community with a shared purpose. Three themes emerged as facilitators: effective leadership, support, and establishing psychological safety during the meetings. Many arrived at the realization that change would take time and advocated for patience and perseverance. Protected time and DEIJ expertise were identified as integral to successful committee work. Our findings provide novel insights into the experience of serving on a GME DEIJ committee and highlights infrastructural and institutional prerequisites for success.