Caregiver and Provider Perceptions of Health Disparities in the NICU: A Qualitative Study.

OBJECTIVES: To describe the experience of caregivers and their perceptions of disparate care in the NICU, and (2) explore inter-professional NICU provider perspectives on potential biases and perceptions of disparate care. METHODS: This qualitative study was conducted in one southeastern level IV NICU. Semi-structured interviews assessed caregiver and provider perspectives on NICU care. Purposive sampling ensured ≥50% of caregivers self-identified as racial and/or ethnic minorities. Interviews were recorded, transcribed verbatim, and audio verified. A coding scheme was developed, raw data were systematically coded, and emerging themes were identified using thematic analyses. RESULTS: 23 caregivers and 14 providers were interviewed, including 5 neonatologists, 6 nurses, and 3 residents. Caregivers were predominantly English-speaking (85%); 96% were mothers with a mean age of 32 years. Neonates were predominantly racial and ethnic minorities (62%). Providers were predominantly White (71%) and female (71%). Five themes emerged: (1) ineffective, biased communication between caregivers, providers, and healthcare team may contribute to disparities (2) language barriers and lack of interpreter access play a significant role in perceived negative care; (3) lack of caregiver involvement and role in decision-making may negatively influence NICU outcomes, especially for those not able to be present at the bedside; and (4) multiple biases may affect neonatal health disparities. CONCLUSION: Our study highlights the importance of considering both provider and racial and/or ethnic minority caregiver perceptions disparities in NICU care delivery. It adds to the literature as one of the few qualitative studies comparing perceptions of disparate NICU care among both caregivers and providers.

Impact of patterns of language use and socio-economic status on a constructed response Situational Judgment Test (SJT).

The study explored the impacts of patterns of language use (PLU) and socio-economic status (SES) on Casper, a constructed-response situational judgment test (SJT). 10,266 applicants from two U.S. medical schools were grouped into self-reported balanced bilinguals, unbalanced bilinguals, English monolinguals, and English as a Second Language (ESL) students. A multicomponent SES composite was used to assess the degree of socioeconomic disadvantage (DSD). Results from a hierarchical regression analysis showed that after accounting for demographic variables, both PLU and DED were significant factors on applicants' Casper performance. Bilingualism was associated with better Casper performance compared to English monolinguals and ESL students. No significant effect of speaking English as a native language was found on applicants' Casper performance. English monolinguals and ESL students performed equivalently on Casper. Finally, high DSD was associated with better Casper performance than low DSD, and the impact of DSD on Casper held the same across all four language groups. These findings provide evidence that socio-cultural factors, such as PLU and DSD have important impacts on SJT performance. Further research is needed to understand the role of differences in language construction across socio-cultural factors on constructed-response SJT performance.

Improving Health Professions Students' Understanding of Interprofessional Roles Through Participation in a Patient Stabilization Simulation.

Objective. To teach interprofessional communication and teamwork skills to health professions students through a standardized patient simulation on acute patient stabilization and measure the impact on learners' perceptions of interprofessional collaboration.Methods. Medical and pharmacy students in their final year and post-licensure nurses in their initial six-month probationary period worked together to stabilize a simulated acutely ill standardized patient. Perceptions of IPE were assessed pre- and post-simulation using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, version 2 (SPICE-R2). Medical student participants' scores were compared to those of a concurrently enrolled cohort of medical students who did not participate in the simulation.Results. Eighty learners participated in the simulation and all completed pre and post SPICE-R2 assessments. Learners' perceptions increased significantly in all domains, including understanding of roles in collaborative practice, interprofessional teamwork and team-based practice, and patient outcomes from collaborative practice. Compared to the control cohort, participants' perceptions of team-based practice and the impact on patient outcomes improved significantly, while a statistically similar improvement in scores for understanding of roles and responsibilities was seen. The SPICE-R2 scores increased similarly among students in each profession. Repeat exposure to the simulation continued to improve perceptions but not as robustly as the initial simulation.Conclusion. This simulation changed learners' perceptions of how interprofessional collaboration affects patient care, which supports the incorporation of standardized patient-based interprofessional education even in the late-stage education of health professionals.

Neonatal Resuscitation: A Blended Learning Curriculum for Medical and Physician Assistant Students.

Introduction: Demonstration of competence in neonatal resuscitation is critical for health care providers who provide newborn care because each year, approximately 400,000 (10%) newborns require resuscitation in delivery rooms across the United States. Therefore, neonatal resuscitation skills certification is provided to graduates entering specific specialties at the beginning of residency and renewed biennially through the American Academy of Pediatrics and the American Heart Association. However, there is no formal curriculum to prepare medical (MD) and physician assistant (PA) students prior to graduation. Methods: We developed a neonatal resuscitation curriculum for MD and PA students using a blended learning approach. The curriculum included web-based interactive teaching modules, a demonstration video of a mock neonatal resuscitation, and a neonatal resuscitation simulation. Final-year MD and PA students were evaluated using pre-/posttest, a neonatal resuscitation checklist, and an optional survey on interprofessional communication skills, roles, and responsibility. Results: Eighteen health professions learners completed the neonatal resuscitation curriculum. A paired-samples t test was conducted to compare pretest and posttest scores. There was a significant difference in pretest (M = 61.4, SD = 15.3) and posttest (M = 78.6, SD = 8.0) scores, t(17) = -4.7, p < .001. The mean score on the checklist was 79%. Learners strongly agreed/agreed that the simulation improved skills performance (100%), communication skills (92%), and understanding of roles and responsibilities (83%) during a neonatal resuscitation. Discussion: There were improvements in knowledge, procedural, and interprofessional skills in learners who received the neonatal resuscitation curriculum.

Building and executing a research agenda toward conducting implementation science in medical education.

BACKGROUND: Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education. APPROACH: We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care. PERSPECTIVES: IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings. CONCLUSIONS: IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely.

Cytokine screening identifies NICU patients with Gram-negative bacteremia.

INTRODUCTION: Biomarkers and physiomarkers may be useful adjunct tests for sepsis detection in neonatal intensive care unit (NICU) patients. We studied whether measuring plasma cytokines at the time of suspected sepsis could identify patients with bacteremia in centers in which patients were undergoing continuous physiomarker screening using a heart rate characteristics (HRC) index monitor. RESULTS: Six cytokines were higher in Gram-negative bacteremia (GNB) than in Gram-positive bacteremia or candidemia (GPBC). A cytokine score using thresholds for granulocyte colony-stimulating factor (G-CSF), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α had 100% sensitivity and 69% positive predictive value (PPV) for GNB. A single cytokine marker, IL-6 < 130 pg/ml, had 100% sensitivity and 52% PPV for sepsis ruled out (SRO). The average HRC index was abnormal in this cohort of patients with clinical suspicion of sepsis and did not discriminate between the final sepsis designations. DISCUSSION: In summary, in NICU patients with suspected late-onset sepsis, plasma cytokines can identify those with SRO and those with GNB, potentially aiding in decisions regarding therapy. METHODS: Seven cytokines were measured in 226 plasma samples from patients >3 d old with sepsis suspected based on clinical signs, abnormal HRC index, or both. Cases were classified as SRO, clinical sepsis (CS), GPBC, or GNB.