Empowering Medical Students to Respond to Discriminatory Comments from Patients: A Just-in-Time Training Method.

This article was migrated. The article was marked as recommended. Physicians in training may experience harassment and discrimination from supervisors, consultants, colleagues, or patients and families. Instances of discrimination towards students may impact students' self-esteem, self-efficacy, and ultimately performance. In this particular time, many institutions are looking to enhance their curriculum regarding bias. More tools are needed to help students feel empowered to respond professionally when they encounter challenging situations. This study was designed to assess the impact of a training intervention in addressing biased patient statements. The training was strategically placed prior to clinical interactions. The authors' intention was to present discriminatory statements by patients as one of the many difficult clinical situations that students are being trained to navigate. The authors developed a clinical rubric for decision-making in flowchart style to mimic the decision trees used in diagnostic or treatment decisions. They then created a workshop to help learners use the flowsheet. The workshop was delivered to third-year medical students as part of "Junior Bootcamp," a day-long session of events to orient students to the clinical experiences of the M3 year. The workshop was delivered in the summer of 2019. Respondents indicated that they were more likely to be able to appropriately respond to discriminatory comments after completing the workshop. They also felt that they were more likely to be able to engage in respectful dialogue with a patient and to debrief with a faculty member. Fewer participants felt that they were likely to use the flowchart. Findings indicate that the workshop was useful to participants. It may be especially useful to educators dealing with the COVID pandemic because it is scalable and easily delivered remotely. Further studies are needed to determine if introducing this topic in the clinical years of medical school leads to improved skill in addressing instances of bias that come from patients and families.

Significados da deficiência adquirida na vida adulta: implicações do trauma raquimedular / Meanings of acquired disability in adulthood: implications of severe spinal cord injury / Significados de la deficiencia adquirida en la edad adulta: implicaciones del trauma raquimedular

Uma lesão medular traumática pode resultar em perdas importantes de diversas funções do organismo, caracterizando assim uma deficiência adquirida. Nesta pesquisa, buscou-se compreender as vivências de pacientes hospitalizados, recém-diagnosticados com um trauma raquimedular, desvelando os significados atribuídos a este acometimento e a consequente deficiência adquirida. Trata-se de uma investigação qualitativa, de caráter exploratório, descritivo, com ênfase nas singularidades dos casos. Participaram dois pacientes do sexo masculino, com idade de 35 e 40 anos, internados em um hospital público, referência em traumas, localizado na região norte do Brasil. Os resultados revelaram perdas significativas como a perda da autonomia e temores relacionados à discriminação e o abandono. Identificou-se que a deficiência adquirida na fase adulta explicita o desafio de ressignificar diferentes aspectos do ser e do viver, o que sinaliza a importância do desenvolvimento de pesquisas acerca da assistência integral a estes pacientes desde o momento do diagnóstico, favorecendo a vivência das perdas sofridas e adaptação à nova condição de vida.

A traumatic spinal cord injury can result in significant losses of various functions of the organism, thus characterizing an acquired disability. The objective of this research was to understand the experiences of hospitalized patients newly diagnosed with spinal cord trauma, revealing the meanings attributed to this affection and the consequent acquired disability. It is a qualitative research, exploratory, descriptive, with an emphasis on the singularities of the cases. Participated in the study two male patients, aged 35 and 40, admitted to a public hospital, reference in traumas located in the northern region of Brazil. The results revealed significant losses, such as loss of autonomy and fears related to discrimination and abandonment. It was identified that the acquired disability in adult phase explains the challenge of re-signifying different aspects of being and of living. This signals the importance of developing research on comprehensive care for these patients from the moment of diagnosis, favoring the experience of suffered losses and adaptation to the new life condition.

Una lesión medular traumática puede desencadenar pérdidas importantes en diversas funciones del organismo, caracterizando así una deficiencia adquirida. En esta recerca se busca comprender las vivencias de los pacientes hospitalizados, recién diagnosticados con trauma raquimedular, desvelando sus significados en este suceso y a la consecuente deficiencia adquirida. Se trata de una investigación cualitativa de carácter exploratorio, descriptivo, con énfasis en las singularidades de los casos. Participaron dos pacientes del sexo masculino, con edades de 35 a 40 años, ingresados en un hospital público, referente en traumas, localizado en la región norte de Brasil. Los resultados revelan pérdidas significativas como la pérdida de la autonomía y miedos relacionados con la discriminación y el abandono. Se identificó que la deficiencia adquirida en la fase adulta explicita el desafío de resignificar los diferentes aspectos del ser y del vivir, lo que señaliza la importancia del desarrollo de investigaciones acerca de la asistencia integral a estos pacientes desde el momento del diagnóstico, favoreciendo la vivencia de las pérdidas sufridas y la adaptación a la nueva condición de vida.