Increasing Health Insurance Enrollment in Low- and Middle-Income Countries: What Works, What Does Not, and Research Gaps: A Scoping Review.

Health insurance programs have the potential to shield individuals in low- and middle-income countries from catastrophic health expenses and reduce their vulnerability to poverty. However, the uptake of insurance programs remains low in these countries. We reviewed existing evidence from experimental studies on approaches that researchers have tested in order to raise the uptake. In the 12 studies we synthesized, educational programs and subsidies were the dominant interventions. Consistent with findings from previous studies on other health products, subsidies were effective in raising the uptake of insurance programs in many contexts. Conversely, education interventions-in their current forms-were largely ineffective, although they bolstered the effect of subsidies. Other strategies, such as the use of microfinance institutions and social networks for outreach and enrollment, showed mixed results. Additional research is needed on effective approaches to raise the uptake of insurance programs, including tools from behavioral economics that have shown promise in other areas of health behavior.

Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates.

BACKGROUND: An endoscopist's adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. AIMS: We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). METHODS: We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). RESULTS: There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR. CONCLUSIONS: Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.

Critical Perspectives to Advance Educational Equity and Health Justice.

A robust body of research supports the centrality of K-12 education to health and well-being. Critical perspectives, particularly Critical Race Theory (CRT) and Dis/ability Critical Race Studies (DisCrit), can deepen and widen health justice's exploration of how and why a range of educational inequities drive health disparities. The CRT approaches of counternarrative storytelling, race consciousness, intersectionality, and praxis can help scholars, researchers, policymakers, and advocates understand the disparate negative health impacts of education law and policy on students of color, students with disabilities, and those with intersecting identities. Critical perspectives focus upon and strengthen the necessary exploration of how structural racism, ableism, and other systemic barriers manifest in education and drive health disparities so that these barriers can be removed.

Jovens em vulnerabilidades psicossociais: grupo como lugar de acolhimento e subjetivação política / Jóvenes en vulnerabilidades psicosociales: grupo como un sitio de recepción e subjetivación política / Young people in psychosocial vulnerabilities: the group as a device for psychological support and political subjectivation

RESUMO. Este artigo visa relatar uma experiência de estágio realizado em um Serviço de Convivência e Fortalecimento de Vínculos (SCFV) junto a jovens de periferias da cidade de Florianópolis (SC), de modo a problematizar as possibilidades e desafios do uso do dispositivo grupal como instrumento de intervenção psicossocial. Este serviço, vinculado à Proteção Social Básica da Política Nacional de Assistência Social (PNAS), tem como objetivo prevenir as situações de riscos e vulnerabilidades, bem como fortalecer os laços familiares e comunitários. Por meio da intervenção grupal, buscamos, junto com estes(as) jovens, criar um espaço de elaboração psíquica e política sobre temas significativos para suas vidas e para a atual sociedade. Apostamos na ideia de que as oficinas propiciaram a construção de um espaço coletivo que servisse de acolhimento ao sofrimento ético-político destes(as) jovens, subsidiando um afago às dores da vida e, também, servindo de catalisador aos processos de subjetivação política frente às iniquidades sociais que atravessam, sistematicamente, o cotidiano destes(as) jovens. Neste trabalho, trazemos reflexões em torno das potencialidades que o dispositivo grupal pode desencadear na constituição do sujeito, compreendendo-o como uma profícua ferramenta de intervenção psicossocial de escuta, acolhimento, fortalecimento comunitário e protagonismo político.

RESUMEN. Este artículo tiene por objeto relatar una experiencia realizada en un Servicio de Convivencia y Fortalecimiento de Vínculos (SCFV) junto a jóvenes de periferias de la ciudad de Florianópolis (SC), de modo a problematizar las posibilidades y desafíos del uso del dispositivo grupal como instrumento intervención psicosocial. Este servicio, vinculado a la Protección Social Básica de la Política Nacional de Asistencia Social (PNAS), tiene como objetivo prevenir las situaciones de riesgos y vulnerabilidades, así como fortalecer los lazos familiares y comunitarios. Por medio de la intervención grupal, buscamos, junto con estos jóvenes, crear un espacio de elaboración psíquica y política sobre temas significativos para sus vidas y para la actual sociedad. Apostamos en la idea de que los encuentros propiciaron la construcción de un espacio colectivo que sirviera de acogida al sufrimiento ético-político de estos jóvenes, subsidiando un ahogo a los dolores de la vida y, también, sirviendo de catalizador a los procesos de subjetivación política frente a las iniquidades sociales que atraviesan sistemáticamente el cotidiano de estos jóvenes. En este trabajo, traemos reflexiones en torno a las potencialidades que el dispositivo grupal puede desencadenar en la constitución del sujeto, comprendiéndolo como una útil herramienta de intervención psicosocial de escucha, acogida, fortalecimiento comunitario y protagonismo político.

ABSTRACT. This article aimed to report an experience developed at a Service of Coexistence and Strengthening of Bonds (SCSB) with young people from outskirts of the city of Florianópolis (SC) problematizing the possibilities and challenges of the use of the group as a psychosocial intervention device. This service, linked to the Basic Social Protection of the National Social Assistance Policy, aims to prevent situations of risks and vulnerabilities, as well as strengthen family and community bonds. Through group intervention, we sought, along with these young people, to create a space of psychic and political elaboration on themes that are significant for their lives and for the current society. We believe that the workshops allowed the construction of a collective space that served as support for the ethical-political suffering of these young people, and also served as a catalyst for the processes of political subjectification fighting the social inequities that permeate the daily lives of these young people. In this work, we brought reflections about the potential that the group device can trigger in the constitution of the subject, understanding it as a useful tool for psychosocial intervention of listening, support, community strengthening and political protagonism.

Autonomia política como prática de cuidado: a gramática da educação zapatista / La autonomía política como práctica del cuidado: la gramática de la educación zapatista / Political autonomy as a practice of care: the grammar of zapatista education

RESUMO. Este artigo tem como objetivo discutir, com bases em diferentes registros, a gramática presente na discursividade de informes oficiais do Movimento Zapatista, no que tange especificamente à educação zapatista, em especial desde a noção de autonomia como modo de organizar esta dimensão da vida em sociedade, entendendo a autonomia como resistência à tutela do Estado na gestão da escola e, micropoliticamente, a ruptura da tutela do processo educativo pelo promotor de educação. Observamos, a partir do estudo das Declarações da Selva Lancadona e da Escuelita Zapatista, que estas fundam-se numa crítica aos modelos estatais de governo da educação, refutando a perspectiva intercultural, defendendo a pluridiversidade. Este modo de compreender o processo educativo, e o modo de praticar o cuidado nos leva a uma compreensão mais ampla para a psicologia, refletindo sobre possibilidades de conexão entre novas invenções psi no trabalho junto à infância e à psicologia da educação.

RESUMÉN Este artículo tiene como objetivo discutir, a partir de diferentes registros, la gramática presente en el discurso de los informes oficiales del Movimiento Zapatista, con respecto específicamente a la educación zapatista, especialmente desde la noción de autonomía como una forma de organizar esta dimensión de la vida en sociedad, entendiendo la autonomía como resistencia a la tutela del Estado en la gestión de la escuela y, micropolíticamente, la ruptura de la tutela del proceso educativo por parte del promotor de la educación. Observamos, a partir del estudio de las Declaraciones de la Selva Lancadona y Escuelita Zapatista, que estos se basan en una crítica a los modelos estatales de gobierno en educación, refutando la perspectiva intercultural, defendiendo la pluridiversidad. Esta forma de entender el proceso educativo, y la forma de practicar el cuidado, nos lleva a una comprensión más amplia de la psicología, reflexionando sobre las posibilidades de conexión entre los nuevos inventos psi en el trabajo con los niños y la psicología de la educación.

ABSTRACT. This article aims to discuss, based on different records, the grammar present in the discourse of Zapatista Movement official reports, specifically regarding the Zapatista education, especially from the idea of autonomy as a way of organizing this dimension of life in society, understanding this autonomy as resistance to State tutelage in the management of schools, as well as the rupture of the educational process tutelage by the promoters of education in micropolitical terms. We observed, based on the study of the Statements of the Selva Lancadona and Escuelita Zapatista, that these are centered on a criticism of state models of government in education, refuting the intercultural perspective, defending pluridiversity. This way of understanding the educational process, and the way of practicing care, leads us to a broader understanding of psychology, reflecting on possibilities of connection between new psychology inventions at work with children and the psychology of education.

Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan.

INTRODUCTION: More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future. METHOD: The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE). RESULTS: The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence. CONCLUSION: The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.

Cardiac electrophysiology and pacing educational and training needs among early-career cardiologists: a national survey of the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing.

BACKGROUND: Over the past three decades, cardiac electrophysiology and pacing, including device therapy and catheter ablation of arrhythmias, has rapidly developed as a subspecialty in cardiology. Currently, there is no clear perception about the needs in cardiac electrophysiology and pacing among early-career cardiologists. METHODS: To address these concerns, the Young Committee of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) carried out a survey among those under the age of 40 years to obtain detailed information on practical activities and formal lessons during the fellowship in cardiology and their satisfaction and proficiency level at the end of the fellowship. RESULTS: We obtained 334 answers to the survey. In invasive cardiac electrophysiology and pacing, the percentage of participants attending the activity for a longer time (3-6 months) is lower compared with those in noninvasive subspecialties. About 40% of participants did not receive lessons on interventional cardiology, cardiac electrophysiology and pacing. On the contrary, 71% of participants received an adequate number of lessons on clinical arrhythmology. The vast majority of the participants expressed satisfaction for the education received in the echocardiographic, cardiac interventional laboratories and clinical arrhythmology, but about half of the participants were unsatisfied with the education received in cardiac electrophysiology and pacing. In interventional arrhythmology, the majority of the participants declare their lack of proficiency with two peaks for more complex procedures, namely interventional electrophysiology procedures (82%) and cardiac resynchronization therapy (CRT) procedures (76%). CONCLUSION: The present survey among Italian early-career cardiologists suggests that the majority of participants consider themselves not confident in performing cardiac electrophysiology and pacing procedures. Due to the complexity of the treatment for heart rhythm disorders and the long learning curve, structured additional training in cardiac electrophysiology and pacing procedures is required after cardiology fellowship.

Asistencia sanitaria y servicios sociales: enseñanza y aprendizaje significativo en talleres técnicos por el método de proyecto / Healthcare and social services: meaningful teaching and learning in technical workshops by the project method

Los derechos humanos, incluyendo la concreción del derecho a la salud, en Perú, contempla el mandato dirigido a los poderes públicos para que organicen la asistencia sanitaria, como elemento causal, específico y adopten el conjunto de medidas necesarias para lograr la prevención de las enfermedades o la mejora de las condiciones sanitarias generales, mediante el método de proyecto en el proceso enseñanza-aprendizaje se abordan los principios rectores de la política social y económica, contenidos del Estado social, y los mecanismos de justiciabilidad y exigibilidad. Se estudió el proceso enseñanza y aprendizaje significativo sobre asistencia sanitaria y servicios sociales en los talleres técnicos, en la Facultad de Derecho y Ciencias Políticas, de la Universidad Peruana Los Andes, durante el periodo lectivo 2019-II. En el egresado conlleva la interacción entre los conocimientos y la información nueva que recibe, en este proceso se construye un nuevo conocimiento o profundiza en los ya existentes. Este conocimiento es organizado y sistemático con conexiones interdisciplinarias entre ideas, se promueve desde el trabajo en equipo y colaborativo, capaz de vencer ambigüedades, complejidades y a lo impredecible; y aprovecha los recursos o herramientas de la vida real, por lo que el método de proyecto es una herramienta pedagógica aplicable a la formación del abogado(AU)

Human rights, including the realization of the right to health, in Peru, contemplates the mandate directed to the public powers to organize health care, as a causal, specific element and adopt the set of measures necessary to achieve the prevention of diseases or the improvement of general sanitary conditions, through the project method in the teaching-learning process, the guiding principles of social and economic policy, contents of the social State, and the mechanisms of justiciability and enforceability are addressed. The teaching and meaningful learning process on health care and social services was studied in technical workshops at the Faculty of Law and Political Sciences, Universidad Peruana Los Andes, during the 2019-II school period. In the graduate, it involves the interaction between knowledge and the new information received, in this process a new knowledge is built or deepens existing ones. This knowledge is organized and systematic with interdisciplinary connections between ideas, it is promoted from team and collaborative work, capable of overcoming ambiguities, complexities and the unpredictable; and it takes advantage of the resources or tools of the real life, reason why the project method is a pedagogical tool applicable to the training of the lawyer(AU)

Formação de Apoiadores Institucionais para o Acolhimento em Redes de Atenção à Saúde (ApI-ARAS): Caderno de Planejamento, Monitoramento e Avaliação (PMA) / Training Institutional Supporters for Reception in Health Care Networks (ApI-ARAS): Planning, Monitoring and Evaluation (PMA) Notebook

Este Caderno de Textos foi elaborado com o propósito de subsidiar o itinerário e gestão na Formação de Apoiadores Institucionais para o Acolhimento em Redes de Atenção à Saúde (ApI-ARAS), no que tange ao Planejamento, Monitoramento e Avaliação, a partir dos pressupostos da Política Nacional de Humanização (PNH) e Política Nacional de Educação Permanente em Saúde (PNEPS). O ApI-ARAS é uma proposta integrada de qualificação das frentes de Apoio Institucional no âmbito do SUS no Tocantins, com o objetivo de fortalecer o Acolhimento em Redes de Atenção à Saúde. Acreditamos que o encontro destes atores no processo formativo tem potencial para o fortalecimento da atuação dos apoiadores institucionais. Este Caderno integra conteúdos referentes ao Planejamento, Monitoramento e Avaliação, articulando com outros Cadernos, especialmente construídos para subsidiar o processo formativo ApI-ARAS, dialogando com os temas previstos na Matriz Curricular do Curso: Apoio como potência e intervenção na realidade; Saúde do(a) trabalhador(a) do SUS; Acolhimento em Redes de Atenção à Saúde; e Eixos avaliativos e indicadores. Neste volume foram contemplados aspectos referentes ao desenho do processo formativo, bases pedagógicas, metodológicas e de intervenção, além do delineamento do monitoramento e avaliação, norteadores para o processo de ensino-aprendizagem e gestão. Esperamos que este material contribua para reflexões acerca das questões que permeiam o universo do trabalho e para a (re)organização do processo de trabalho em saúde, promovendo a autonomia dos sujeitos envolvidos na produção de saúde.

This Textbook was prepared with the purpose of subsidizing the itinerary and management in the Training of Institutional Supporters for Reception in Health Care Networks (ApI-ARAS), with regard to Planning, Monitoring and Evaluation, based on the assumptions of the National Humanization Policy (PNH) and National Policy on Permanent Education in Health (PNEPS). ApI-ARAS is an integrated proposal for the qualification of Institutional Support fronts within the scope of the SUS in Tocantins, with the objective of strengthening the Reception in Health Care Networks. We believe that the meeting of these actors in the training process has the potential to strengthen the performance of institutional supporters. This Notebook integrates contents related to Planning, Monitoring and Evaluation, articulating with other Notebooks, specially built to subsidize the ApI-ARAS training process, dialoguing with the themes foreseen in the Curriculum Matrix of the Course: Support as power and intervention in reality; Health of SUS workers; Reception in Health Care Networks; and Evaluation axes and indicators. In this volume, aspects related to the design of the training process, pedagogical, methodological and intervention bases, in addition to the design of monitoring and evaluation, guiding the teaching-learning and management process were considered. We hope that this material will contribute to reflections on the issues that permeate the universe of work and for the (re)organization of the health work process, promoting the autonomy of the subjects involved in the production of health.

Este Libro de Texto fue elaborado con el propósito de subsidiar el itinerario y la gestión en la Formación de Apoyos Institucionales para la Acogida en Redes de Atención a la Salud (API-ARAS), en lo que se refiere a Planificación, Seguimiento y Evaluación, con base en los presupuestos de la Política Nacional de Humanización ( PNH) y Política Nacional de Educación Permanente en Salud (PNEPS). ApI-ARAS es una propuesta integrada para la calificación de frentes de Apoyo Institucional en el ámbito del SUS en Tocantins, con el objetivo de fortalecer la Acogida en las Redes de Atención a la Salud. Creemos que el encuentro de estos actores en el proceso de formación tiene el potencial de fortalecer la actuación de los promotores institucionales. Este Cuaderno integra contenidos relacionados con la Planificación, Seguimiento y Evaluación, articulándose con otros Cuadernos, especialmente construidos para subsidiar el proceso de formación ApI-ARAS, dialogando con los temas previstos en la Matriz Curricular del Curso: Apoyo como poder e intervención en la realidad; Salud de los trabajadores del SUS; Acogida en Redes de Atención a la Salud; y Ejes e indicadores de evaluación. En este volumen se consideraron aspectos relacionados con el diseño del proceso de formación, bases pedagógicas, metodológicas y de intervención, además del diseño de seguimiento y evaluación, orientando el proceso de enseñanza-aprendizaje y de gestión. Esperamos que este material contribuya a la reflexión sobre las cuestiones que permean el universo del trabajo y para la (re)organización del proceso de trabajo en salud, promoviendo la autonomía de los sujetos involucrados en la producción de salud.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

Socioscientific Issues in Science Education: An opportunity to Incorporate Education about Risk and Risk Analysis?

Socioscientific issues (SSI) concern social issues, often lacking simple solutions, that relate to science and often also risk controversies. SSIs have become an established part of science education, aiming to teach students not only about content knowledge but also about the nature of science and to offer them practice in argumentation and decision making. We performed a scoping review of the literature on SSI in science education research, in order to investigate if the topics covered would lean themselves to education about risk, and if risk is raised in these works. Using Web of Science we identified 296 empirical publications and 91 theoretical or review publications about SSI teaching in science education. The empirical publications covered studies performed in primary to tertiary school, most commonly upper secondary school (32%). The most frequently taught SSI themes were nature conservation, biotechnology, and climate change. Despite that these, as most of the other identified themes, clearly are connected to risk analysis and risk management, few publications raised the concept of risk and the methods of risk analysis. In fact, almost half (empirical: 48%, theoretical: 49%) did not mention risk at all. We argue that SSIs present an opportunity for risk researchers to engage with educators to incorporate risk in school science education and to contribute in developing teaching materials suitable toward that aim.

Scholarly Research Productivity among Otolaryngology Residency Graduates and its Relationship to Future Academic Achievement.

OBJECTIVE: Scholastic activity through research involvement is a fundamental aspect of a physician's training and may have a significant influence on future academic success. Here, we explore publication rates before, during, and after otolaryngology residency training and whether publication efforts correlate with future academic achievement. METHODS: This cross-sectional analysis included a random sample of 50 otolaryngology residency programs. From these programs, we assembled a list of residents graduating from the years in 2013, 2014, and 2015. Using SCOPUS, PubMed, and Google Scholar, we compiled the publications for each graduate, and data were extracted in an independent, double-blinded fashion. RESULTS: We included 32 otolaryngology residency programs representing 249 residents in this analysis. Graduates published a mean of 1.3 (SD = 2.7) articles before residency, 3.5 (SD = 4.3) during residency, and 5.3 (SD = 9.3) after residency. Residents who pursued a fellowship had more total publications (t247 = -6.1, P < .001) and more first author publications (t247 = -5.4, P < .001) than residents without fellowship training. Graduates who chose a career in academic medicine had a higher number of mean total publications (t247 = -8.2, P < .001) and first author publications (t247 = -7.9, P < .001) than those who were not in academic medicine. There was a high positive correlation between residency program size and publications during residency (r = 0.76). CONCLUSION: Research productivity correlated with a number of characteristics such as future fellowship training, the pursuit of an academic career, and overall h-index in this study.

Gastroenterology Fellowship Applicants' Perspectives on GI Program Preferences.

Gastroenterology fellowship continues to be highly competitive among internal medicine subspecialties. Recruiting excellent applicants is also important for GI fellowship program directors. We aim to examine factors that influence GI fellowship applicants' perspectives about a fellowship program. The authors conducted an anonymous online survey of applicants focusing on program characteristics including location, faculty, research/clinical opportunities, website, and interview day experience. Anonymous survey responses were recorded regarding program characteristics, and subsequent candidate preferences were evaluated for factors influencing their decision. Candidates were also asked to evaluate their interview experience and share other comments about the program. Though GI fellowship applicants have varying preferences regarding the ideal training program, some opinions converged. The study of these trends can inform program directors regarding areas for improvement that in turn can help attract the best applicants.

Decision-making capacity assessment education.

BACKGROUND/OBJECTIVES: As the elderly population and associated number of persons with dementia increase, so does the need for decision-making capacity assessments (DMCAs). Many healthcare professionals (HCPs), however, do not feel prepared to conduct DMCAs. We have provided 4-h DMCA workshops to HCPs since 2006 and offered physicians either a 3-h or 2-day DMCA workshop from 2013 to present. We evaluated the effectiveness of the workshops on self-reported key concepts of capacity. DESIGN: Pre-/post-test design. SETTING: DMCA workshops for physicians across Canada and HCPs within Alberta. PARTICIPANTS: Two hundred and eighty-one physicians and 835 HCPs. MEASUREMENTS: Pre-/post-workshop ratings on level of comfort with and understanding of 15 core DMCA concepts using 4-point Likert-type items. RESULTS: For the DMCA workshops among physicians, ten 3-h workshops were held in 2014-2015 with 166 participants and seven 2-day workshops, between 2014 and 2018, with 115 participants. With respect to the self-report on core DMCA concepts, at least 62.7% (range: 62.7%-89.6%) of physician participants had higher post-workshop ratings (sign test; p < 0.001) than pre-workshop ratings for all core DMCA concepts. For the DMCA workshops among HCPs, 4-h workshops were delivered to 835 HCP participants from 2008 to 2012. At least 49.6% of participants (range: 49.6%-78.9%) had increased post-workshop ratings (sign test; p < 0.001) for all level of comfort items with and understanding of core DMCA concepts. CONCLUSION: There is a need for DMCA training for physicians and HCPs. The content and method of the workshops are effective at enhancing self-reported level of comfort with and understanding of core DMCA concepts.

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.