Case-Based Immigrant Health Ethics Curriculum: A Pathway to Improve Care and Advocacy.

Introduction Immigrants comprised a significant portion of the total population in the United States (US), and a considerable number of children in the US live with at least one immigrant parent, which has continued to increase over the past decades. However, healthcare providers (HPs) in the US report lack of comfort in interacting with immigrant and refugee populations. Methods The authors, in partnership with the Midwest Consortium of Global Health Educators, developed an innovative, interactive ethics curriculum within the Immigrant Partnership Advocacy and Curricular Kit (I-PACK). They sought to increase HPs' confidence in navigating complex encounters with immigrant families by teaching a relevant ethical framework, highlighting the importance of cultural humility, and equipping learners with an ethics tool (five-box Method) for use in clinical encounters. They piloted the curriculum during three workshop sessions in 2020-2021, and this curriculum continues to be used nationally as a part of I-PACK. Results Pre- and post-session surveys indicated that all participants (100%, n=22) reported acquisition of new skills/knowledge and 19 (86%) felt confident applying this to their clinical practice. The participants reported appreciation for an ethical framework with which to analyze cases, enjoyment of active participation in small group discussions, and utility of the five-box method tool. Some areas of improvement offered were to have more cases and more time dedicated to small-group discussions. Conclusions Given the success of the I-PACK ethics curriculum pilot, the authors plan to incorporate immigrant health cases in the general ethics training in medical school classes and pediatric residency training. Furthermore, they will advocate for the importance of including immigrant health ethics across graduate medical education, as fluency and competence in navigating the ethics of immigrant health are required to provide patient-centered, culturally informed care to all populations.

The Effect of a Mock Medical Visit on Refugee Health Self-Efficacy and Medical Trainee Communication Apprehension.

INTRODUCTION: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health. METHODS: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees. RESULTS: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10). DISCUSSION: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.

The medical transition of young adults with type 1 diabetes (T1D): a retrospective chart review identifies areas in need of improvement.

BACKGROUND: The transition process from pediatric to adult care in individuals with T1D has long-term ramifications on health outcomes. Recognition of differences in care delivery and changes made in management during this time may improve the process. We hypothesized that pediatric providers would be less likely to address T1D-related comorbidities than their adult counterparts, highlighting opportunities to strengthen care. METHODS: A retrospective chart review of patients aged 16-21 years diagnosed with T1D before age 18 was performed. Data on diagnosis, screening, and management of hypertension, dyslipidemia, microalbuminuria, retinopathy, and neuropathy were collected for 1 year before and 1 year after transition to adult care. The 'ADA Standards of Medical Care in Diabetes' were used to determine adherence to the above parameters. Data before and after transition was compared by Fischer's Exact and Exact McNemar tests. RESULTS: Complete medical records for 54 subjects were reviewed before and after transition from pediatric to adult care providers within a single academic medical system (52% male; 78% Caucasian). Transition to adult care occurred at a mean age of 18 years. Mean length of transition was 7.8 months with no significant change in an individual's HbA1c over that time. Over the transition period, there was no difference in diagnoses of hypertension or the use of anti-hypertensive. Adherence to lipid and retinopathy screening was similar across the transition period; however, adherence to microalbuminuria screening was higher after the transition to adult providers (p = 0.01). Neuropathy screening adherence was overall poor but also improved after transition (p < 0.001). CONCLUSIONS: Overall, there were no significant changes in the diagnosis or management of several T1D-related comorbidities during the transition period in a small cohort of young adults with T1D. The transition length was longer than the recommended 3-months, highlighting an opportunity to improve the process. There was no deterioration of glycemic control over this time, although HbA1c values were above target. Adult providers had significantly higher rates of adherence to screening for microalbuminuria and neuropathy than their pediatric counterparts, but adherence for neuropathy was quite poor overall, indicating a need for practice improvement.