From East to West: A Narrative Review of Healthcare Models in India and the United States.

The global healthcare landscape is fraught with quality, cost, equity, and innovation challenges. Despite this, successful healthcare interventions have emerged from unexpected locations. In India, the eradication of certain communicable diseases, the expansion of access to primary care, and the implementation of innovative methods such as telemedicine have demonstrated the potential for community-centered care. In the United States (US), improvements in healthcare quality, accessibility, and the utilization of medical technology, such as the incorporation of telehealth and artificial intelligence, have highlighted opportunities for technological innovation in healthcare delivery. This manuscript reviews the history and development of healthcare systems in India and the US, highlighting each system's strengths, weaknesses, lessons learned, and opportunities for improvement. By examining both systems, we strive to promote a healthcare model that incorporates lessons from each country to improve community-centered care and ultimately provide equitable access to all.

Integration of Sex and Gender Minority Standardized Patients into a Workshop on Gender-Inclusive Patient Care: Exploring Medical Student Perspectives.

OBJECTIVES: Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop. RESULTS: Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session. CONCLUSIONS: Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.

Family Medicine Clerkship Assessment Analysis: Application and Implications.

INTRODUCTION: Clerkship assessment structures should consist of a systematic process that includes information from exam and assignment data to legitimize student grades and achievement. Analyzing student performance across assessments, rather than on a single assignment, provides a more accurate picture to identify academically at-risk students. This paper presents the development and implications of a structured approach to assessment analysis for the Family Medicine Clerkship at Florida International University Herbert Wertheim College of Medicine. METHODS: The assessment analysis included a table presenting the distribution of all assessment performance results for 166 clerkship students from April 2018 to June 2019. A correlation table showed linear relationships between performance on all graded activities. We conducted a Pearson analysis (r), coefficient of determination (r 2), multiple regression analysis, and reliability of performance analysis. RESULTS: Performance on one assessment-the core skills quiz-yielded a statistically significant correlation (r=.409, r 2= .16, P<.001) with the final clerkship grade. The reliability of performance analyses showed low performers (<-1.7 SD), had both a low mean quiz score (59.6) and final grade (83). Top performers (>-1.7 SD) had both a high mean quiz score (88.5) and final grade (99.6). This was confirmed by multiple regression analysis. CONCLUSION: The assessment analysis revealed a strong linear relationship between the core skills quiz and final grade; this relationship did not exist for other assignments. In response to the assessment analysis, the clerkship adjusted the grading weight of its assignments to reflect their utility in differentiating academic performance and implemented faculty development regarding grading for multiple assignments.

Connecting Primary Care Providers in Free Clinics with Specialists Via Telehealth: A Pilot Program with Three Miami Clinics.

The Medical Alumni Volunteer Expert Network (MAVEN) Project (MP) in Miami, Florida piloted primary care provider (PCP)-specialist telehealth consults in three clinics for the uninsured. Preliminary findings suggest telehealth consults may improve quality of care, provider knowledge, and confidence, and may represent innovative health care delivery for the uninsured.

Using a Hybrid Lecture and Small-Group Standardized Patient Case to Teach the Inclusive Sexual History and Transgender Patient Care.

OBJECTIVES: Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. RESULTS: After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. CONCLUSIONS: Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.

Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum.

INTRODUCTION:  To educate students about social determinants of health, our medical school assigns interprofessional student teams to work longitudinally with underserved households to identify and address their health and social needs. To cultivate reflective practice--an essential component to training competent professionals through service-learning programs--students are asked to recognize their emotional responses to patient encounters. This project used reflective essays to identify the emotional responses of medical students to the start of their household visit experience and to assess their observations in relation to social determinants of health. METHODS:  Thematic analysis was used to examine patterns in reflective essays provided by 99 medical students. Two independent reviewers read the essays and created initial codes, which were developed into a common codebook by consensus. Codes were categorized into themes, including observations of the social determinants and emotional reactions to household visits. RESULTS: Through the provision of household-centered care, medical students recognize the roles that social determinants play in the health of patients, households, and communities. Furthermore, they are able to identify household and community level interventions to address these identified needs. A variety of emotional responses to household visits were identified, ranging from frustration and sadness to empathy and humility.  Conclusions: Medical students undergo an emotional evolution even at the start of their household visit experience; highlighting that early patient care responsibilities play an important role in their development from pre-professional students to doctors-in-training. Additionally, student observations of the social determinants suggest that household visits can provide an opportunity for the application of knowledge about identifying and addressing these barriers to care.

Evaluating the Quality of Overactive Bladder Patient Education Material on YouTube: A Pilot Study Using the Patient Education Materials Assessment Tool.

OBJECTIVES: To assess the characteristics and quality of patient education content for overactive bladder (OAB) on YouTube. METHODS: We searched YouTube on September 10, 2019 and reviewed the top 25 search results for "overactive bladder." For comparison, we reviewed 3 Urology Care Foundation (UCF) OAB education videos on YouTube. Videos were scored using the Agency for Healthcare Research and Quality's Patient Education Materials Assessment Tool (PEMAT) for Audiovisual materials, which is subdivided into understandability and actionability domains, each with a maximum score of 100%. RESULTS: The mean length was 9.5 (0.9-34) minutes and the mean number of views was 151,382 (127-2,032,441). Of the top 25 search results, the mean PEMAT understandability score was 74% ± 16% (range 41%-100%). The mean PEMAT actionability score was 57% ± 39% (range 0%-100%). Seventy-two percent of the reviewed videos featured a physician. In comparison, the 3 UCF videos had an average of 5840 views, 3 minutes length, and PEMAT understandability and actionability scores of 93% and 100%. All UCF OAB videos featured urologists. CONCLUSION: The quality of OAB patient education materials on YouTube varies significantly in understandability and actionability. Although the UCF videos scored much higher on the PEMAT than our reviewed videos, they did not appear within the top 25 search results for OAB. There is great opportunity for the American Urological Association (AUA)/UCF and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) to increase its outreach to patients on platforms like YouTube.

Pilot Study of a Free Long-Acting Reversible Contraception Program on a Mobile Health Center in Miami Dade County, Florida.

In 2016, the NeighborhoodHELP mobile health centers (MHCs) started to provide free long acting reversible contraception (LARC) for uninsured patients who lacked access due to cost. All female patients with appointments from May 1st, 2016 through April 30th, 2017 were identified. LARC uptake rate, as well as demographics for patients aged 15-44 who underwent LARC insertion versus those who did not, were determined. Of the 520 female patients seen on the MHCs during the study period, 170 were of reproductive age. Seventeen (10%) patients opted for LARC; 100 % of these patients spoke Spanish or English and 82 % identified as White and Hispanic/Latino. Results show a 10% LARC uptake, which is slightly above the national rate, but lower than rates in other studies in which cost barriers were removed. Further investigation into barriers influencing LARC uptake in our patient population is warranted.

Let's Talk About Sex: The Social Determinants of Sexual and Reproductive Health for Second-Year Medical Students.

Introduction: Sexual health is influenced by a myriad of social factors including health care access, social and cultural norms, insurance status, educational level and health literacy, economic status, sex, gender identity, and sexual orientation and behavior. It is pivotal to educate future physicians about these social determinants so that they can work to mitigate the resulting disparities and thereby improve the health of patients and their communities. Methods: This 2-hour, large-group session for second-year medical students was first given in the fall of 2017. It included a 1-hour, case-based lecture followed by a patient panel. Panelists discussed their interactions with the medical system and how these related to their sex and gender identity. Ninety students (77.5% response rate) completed both pre- and postsurveys and an overall assessment of the session. Results: Students reported high levels of satisfaction with the session. Eighty-seven percent felt they would benefit from more classes including a patient panel, and 93% reported specifically that the panel helped them to identify their own biases related to sexual orientation and gender. In the postsurvey, there was a significant (p < .05) increase in the number of students reporting increased comfort regarding various aspects of sexual history taking and interacting with patients of different sexual orientations and gender identities. Discussion: This instructional format provided an effective way to teach medical students about the social determinants of sexual and reproductive health. Students both appreciated the session format and reported increased comfort and confidence related to the subject matter.

Attitudes and preferences toward the provision of medication abortion in an urban academic internal medicine practice.

BACKGROUND: Mifepristone offers internal medicine doctors the opportunity to greatly expand access to abortion for their patients. Almost 70% of pregnancy terminations, however, still occur in specialized clinics. No studies have examined the preferences of Internal Medicine patients specifically. OBJECTIVE: Determine whether patient preference is a reason for the limited uptake of medication abortion among internal medicine physicians. PARTICIPANTS: Women aged 18-45 recruited from the waiting room in an urban academic internal medicine clinic. MEASURES: A semi-structured questionnaire was used to determine risk of unintended pregnancy and attitudes toward abortion. Support for provision of medication abortion in the internal medicine clinic was assessed with a yes/no question, followed by the open-ended question, "Why do you think this clinic should or should not offer medication abortion?" Subjects were asked whether it was very important, somewhat important, or not important for the internal medicine clinic to provide medication abortion. KEY RESULTS: Of 102 women who met inclusion criteria, 90 completed the survey, yielding a response rate of 88%. Twenty-two percent were at risk of unintended pregnancy. 46.7% had had at least one lifetime abortion. Among those who would consider having an abortion, 67.7% responded yes to the question, "Do you think this clinic should offer medication abortions?" and 83.9% stated that it was "very important" or "somewhat important" to offer this service. Of women open to having an abortion, 87.1% stated that they would be interested in receiving a medication abortion from their primary care doctor. CONCLUSIONS: A clinically significant proportion of women in this urban internal medicine clinic were at risk of unintended pregnancy. Among those open to having an abortion, a wide majority would consider receiving it from their internal medicine doctor. The provision of medication abortion by internal medicine physicians has the potential to greatly expand abortion access for women.