Healthcare disparities in rheumatology: the role of education at a global level.

All fields of medicine are victim to health inequity worldwide, including rheumatology. While the health system is a key proponent to health access for all, other social determinants of health also impact world health. We describe herein the current state of global healthcare disparities in rheumatology and attempts at optimizing graduate medical education and resources for optimized healthcare, international research collaborations and a future of universal health equity. We performed a comprehensive search through Pubmed using the following keywords: healthcare disparities, medical education, access to care, community health.Key Points• Healthcare disparities are ubiquitous globally, including the field of rheumatology.• The heterogeneity of global healthcare disparities emphasizes the importance of addressing unmet needs at a regional level.• A standardized approach to incorporating healthcare disparities education in the medical field is lacking. Intervening at this level provides a foundation of increasing provider awareness of regional healthcare disparities so as to establish a framework of addressing such disparities in a culturally competent manner.

Addressing Health Disparities in Medical Education and Clinical Practice.

Health and health care disparities are present in every medical specialty, and stem from multiple etiologies. Within health care itself, issues mostly arise within medical providers and across a system with an inequitable distribution of care and resources. One potential way to address disparities is to educate our workforce, to not only know about disparities but to also actively advocate for underresourced and marginalized patients. In this review, the authors describe efforts being conducted in graduate medical education and seek to elucidate some of the curricula currently being developed and implemented in rheumatology.

Fellow use of medical jargon correlates inversely with patient and observer perceptions of professionalism: results of a rheumatology OSCE (ROSCE) using challenging patient scenarios.

The NYC Rheumatology Objective Structured Clinical Examination (NYC-ROSCE) is held annually to assess fellow competencies. We recently redesigned our OSCE to better assess subspecialty trainee communication skills and professionalism by developing scenarios in which the patients encountered were psychosocially or medically complex. The objective of this study is to identify which types of verbal and non-verbal skills are most important in the perception of professionalism in the patient-physician interaction. The 2012-2013 NYC-ROSCEs included a total of 53 fellows: 55 MD evaluators from 7 NYC rheumatology training programs (Hospital for Special Surgery-Weill Cornell (HSS), SUNY/Downstate, NYU, Einstein, Columbia, Mount Sinai, and North Shore/Long Island Jewish (NSLIJ)), and 55 professional actors/standardized patients participated in 5 stations. Quantitative fellow performance assessments were made on the following: maintaining composure; partnering with the patient; honesty; professionalism; empathy; and accountability. Free-text comments were solicited regarding specific strengths and weaknesses. A total of 53/53 eligible (100 %) fellows were evaluated. MD evaluators rated fellows lower for professionalism than did the standardized patients (6.8 ± 0.6 vs. 7.4 ± 0.8, p = 0.05), suggesting that physicians and patients view professionalism somewhat differently. Fellow self-evaluations for professionalism (6.6 ± 1.2) were concordant with those of the MD evaluators. Ratings of empathy by fellows themselves (6.6 ± 1.0), MD evaluators (6.6 ± 0.7), and standardized patients (6.6 ± 1.1) agreed closely. Jargon use, frequently cited by evaluators, showed a moderate association with lower professionalism ratings by both MD evaluators and patients. Psychosocially challenging patient encounters in the NYC-ROSCE permitted critical assessment of the patient-centered traits contributing to impressions of professionalism and indicate that limiting medical jargon is an important component of the competency of professionalism.

The Duero Diatom Index (DDI) for river water quality assessment in NW Spain: design and validation.

Diatom indices developed in certain geographic regions are frequently used elsewhere, despite the strong evidence that such metrics are less useful when applied in regions other than that where species-environment relationships were originally assessed, showing that species have particular autoecological requirements in different geographic areas. The goal of this study was to develop a new metric, the Duero Diatom Index (DDI), aimed at monitoring water quality in Duero basin watercourses (NW Spain). In summer 2008 and 2009, a total of 355 epilithic diatom samples were collected following standard protocols. The 2008 samples were used to develop the DDI, whereas the samples collected during 2009 were used in the index testing. Weighted averages method was used to derive the autoecological profiles of diatoms with respect to pH, conductivity, biological oxygen demand, ammonia, nitrates, and phosphates. The optimum and tolerance values for the measured environmental variables were determined for 137 taxa with abundances and frequencies of occurrence above 1%, and subsequent trophic indicator and sensitivity values were defined for the DDI. The correlation between the observed and the diatom-inferred nutrient concentrations was highest for phosphates (ρ (S) = 0.72). Significant statistical relationship were observed between DDI values and the chemistry-based General Quality Index values (p = 0.006) and the specific pollution index (SPI) diatom metric (p = 0.04). DDI has demonstrated a better correlation with water chemistry than SPI diatom metric.

SLE: serving the underserved in an academic medical center.

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder that can cause significant morbidity and mortality. SLE typically affects women during their childbearing years, and can disproportionately affect racial and ethnic minorities. Because this disease afflicts them at the height of their youth, patients often carry a large psychosocial burden. This is especially the case in groups that may have to grapple with other issues such as poverty, work disability, and lack of insurance. In this review we look at these issues, and how they affect patients at one major academic center in the Bronx, NY.