Driving toward a culture shift: Case studies of social mission in nursing education.

BACKGROUND: Nursing schools need to provide students with the appropriate tools to develop competencies and resources to actualize moral courage to advance health equity and center social mission. PURPOSE: The purpose of this study was to describe six nursing programs that exemplify a variety of ways that social mission goals are pursued in different contexts. METHOD: Using a case study approach, we selected nursing schools that excelled in at least one of the following social mission domains: education program, community engagement, governance, diversity & inclusion, institutional culture & climate and research. We conducted video interviews with the administration, faculty and students. FINDINGS: Main themes were: (1) central university/college commitment; (2) allocation of school resources; (3) faculty buy-in; (4) community partnerships; and, (5) an institutional culture of inclusion. DISCUSSION: While each school approaches social mission differently, there are commonalities across cases including a number of necessary factors for schools to advance their social mission goals.

Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs.

Importance: Medical school pathway programs are a strategy to increase the diversity of the physician workforce. The COVID-19 pandemic may have negatively affected pathway programs, further challenging efforts to increase diversity. Objectives: To describe the changes in medical school pathway programs during the COVID-19 pandemic and identify methods for sustaining and supporting these programs during and after the pandemic. Design, Setting, and Participants: A survey study using an exploratory sequential mixed-method design was conducted from January 4 to August 3, 2021. Semistructured interviews with a sample of medical school pathway program administrators and academic leaders of US allopathic and osteopathic medical school diversity pathway programs identified themes and patterns of change to pathway programs since the onset of the pandemic compared with previous years. These themes were used to develop a survey that was sent to medical schools to assess the association between COVID-19 and their programs. Main Outcomes and Measures: The association between the COVID-19 pandemic and medical school diversity pathway programs was explored using interview and survey data assessing respondent characteristics; changes in the scope, size, and funding of programs in 2020 compared with previous years; and respondents' perceptions of future needs for pathway programs. Results: Twelve program administrators and academic leaders were interviewed. Interviews revealed challenges and benefits of virtual programming in engaging and reaching students and speakers, the value of community partnerships to sustaining programming, and the importance of psychosocial support to mediating students' mental health challenges due to COVID-19 and remote learning. Of 198 schools surveyed in the quantitative phase, 112 responded (56.6%), 106 (94.6%) of which had been sponsoring or assisting with pathway programs during the COVID-19 pandemic. Forty-two respondents (39.6%) had reduced pathway programs since the onset of the COVID-19 pandemic compared with the previous year. Program cancellations were more likely to be noted in elementary school-aged (50.0% decrease in programming; P = .01) and middle school-aged (32.6%; P = .02) students compared with older groups. Conclusions and Relevance: In this survey study, schools indicated that pathway programs were disrupted by COVID-19. Ongoing and flexible supports may be needed to sustain these programs. These findings are timely given recent investments in equity-focused programs to diversify the health workforce.

Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US.

Importance: The COVID-19 pandemic and calls for racial justice have highlighted the need for schools to promote social mission. Measuring social mission engagement and performance in health professions education may encourage institutional efforts to advance health equity and social justice commitments. Objective: To describe the current state of social mission commitment within dental, medical, and nursing schools in the US and to examine how social mission performance compares across school types. Design, Setting, and Participants: This cross-sectional survey study invited all US dental and medical schools and a subset of baccalaureate- and master's degree-conferring nursing schools to participate in a self-assessment to measure their school's social mission commitment from January 29 through October 9, 2019. The survey measured 79 indicators (with indicators defined as responses to specific scored questions that indicated the state or level of social mission commitment) across 18 areas in 6 domains of school functioning (educational program, community engagement, governance, diversity and inclusion, institutional culture and climate, and research) that have potential to enhance social mission engagement and performance. Individual health professions schools were the unit of analysis, and 689 dental, medical, and nursing schools were invited to participate. School deans and program directors were the primary target respondents because of their broad insight into their school's programs and policies and their ability to request data from various internal sources. Demographic information from respondents was not collected because multiple respondents from an institution could complete different sections of the survey. Main Outcomes and Measures: Survey responses were analyzed to create indicator scores, standardized area scores, and an overall social mission score for each school. Using descriptive analyses, frequency and contingency tables of specific indicators within each area were created, and schools were compared based on ownership status (private or public), Carnegie Classification of Institutions of Higher Education research classification group (doctoral university with very high research activity [R1], doctoral university with high [R2] or moderate [R3] research activity, baccalaureate or master's nursing college or university, or special focus institution), and discipline group (dental school, medical school granting doctor of osteopathic medicine [DO] degrees, medical school granting doctor of medicine [MD] degrees, nursing school granting baccalaureate-level degrees, or nursing school granting master's-level degrees). Results: Among 689 invited schools, 242 schools (35.1%) completed the self-assessment survey. Of those, 133 (55.0%) were nursing schools, 83 (34.3%) were medical schools, and 26 (10.7%) were dental schools. Response rates ranged from 133 of 420 invited nursing schools (31.7%) to 83 of 203 invited medical schools (40.9%). Most schools included social determinants of health in their curriculum in either required courses (233 of 242 schools [96.3%]) or elective courses (4 of 242 schools [1.7%]), but only 116 of 235 schools (49.4%) integrated social determinants of health across all years of study. Most schools also included health disparities in either their required courses (232 of 242 [95.9%]) or elective courses (6 of 242 [2.5%]); however, only 118 of 235 schools (50.2%) integrated health disparities across all years of study. In several areas of social mission, public schools performed better than private schools (eg, curriculum: mean [SE] standardized area score, 0.13 [0.07] points vs -0.14 [0.09] points, respectively), and R1 doctoral universities and special focus institutions performed better than R2 and R3 doctoral universities and baccalaureate and master's nursing colleges and universities (eg, extracurricular activities: mean [SE] standardized area score, 0.25 [0.09] points for R1 doctoral universities and 0.20 [0.12] points for special focus institutions vs -0.05 [0.12] points for R2 and R3 doctoral universities and - 0.30 [0.12] points for baccalaureate and master's nursing colleges and universities. Different areas of strength emerged for dental, medical, and nursing schools. For example, in the curriculum area, MD-granting medical schools had a mean (SE) standardized area score of 0.38 (0.08) points, which was significantly higher than the standardized area scores of dental schools (mean [SE], -0.21 [0.14] points), DO-granting medical schools (mean [SE], -0.22 [0.13] points), graduate nursing schools (mean [SE], -0.21 [0.19] points), and undergraduate nursing schools (mean [SE], -0.05 [0.10] points). Conclusions and Relevance: In this study, there was widespread interest from health professions educational leaders in understanding and enhancing social mission commitment. Future work may focus on identifying and promoting best practices using the framework described, providing schools with continued opportunities for self-assessment, and further validating the self-assessment survey.

The Scope of Social Mission Content in Health Professions Education Accreditation Standards.

PURPOSE: Health professions education accreditation standards influence institutional practices and policies and ensure high-quality education that meets the needs of patients and society. Social mission is the contribution of a school in its mission, programs, and the performance of its graduates, faculty, and leadership to advancing health equity and addressing the health disparities of the society in which it exists. This study examined the scope of social mission content in major U.S. and Canadian health professions education accreditation standards. METHOD: The authors analyzed publicly available accreditation standards documents from 9 accreditors across 5 disciplines-dental, medical, nursing, pharmacy, and physician assistant schools-with effective years from 2016 to 2020. They created a codebook from the previously published social mission metrics survey, which includes 18 social mission activity areas and 79 indicators within those areas. The authors then conducted detailed document reviews to identify the presence of the social mission areas and indicators within the accreditation standards. RESULTS: Across all 18 activity areas and 9 accreditors, the authors identified 93 instances of social mission. Curriculum was the most well-represented area with 34 instances. Interprofessional education in curriculum was the most prevalent indicator with 17 instances. The Committee on Accreditation of Canadian Medical Schools included more social mission areas and indicators than the other accreditors. CONCLUSIONS: There is substantial variability in the social mission content in accreditation standards across accreditors and disciplines. The authors found little representation of key aspects of social mission, including community collaborations, faculty training, and pipeline programs. These findings highlight areas of potential interdisciplinary collaboration to enhance the social mission content of health professions education.

SAPHO Syndrome: An Unusual Cause of Dysphagia.

CASE PRESENTATION: This case describes a 51-year-old male who presented to the emergency department with a complaint of two weeks of progressively worsening dysphagia as well as the emergence of superficial fluid collections on the anterior chest and leg during the same period. Computed tomography showed retropharyngeal and paratracheal fluid collections with adjacent vertebral osteitis; however, biopsies were negative for any infectious or mycobacterial source, and instead showed chronic inflammatory changes. DISCUSSION: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare rheumatic disorder that presents with multifocal osteitis and sterile neutrophilia. SAPHO syndrome may be easily mistaken for a diffuse infectious process on initial evaluation and imaging; however, it is treated with anti-inflammatory medications, including non-steroidal anti-inflammatory drugs and corticosteroids. Although most patients achieve remission of symptoms with treatment, the location of the fluid collections and resultant bony destruction may be life-threatening if undiagnosed.

Social Mission Metrics: Developing a Survey to Guide Health Professions Schools.

The social mission, which is focused on advancing social justice and health equity, has gained recognition as an important aspect of health professions education. However, there is currently no established method to measure a school's commitment to these activities. In this Perspective, the authors describe the development of a new tool to measure the social mission at dental, medical, and nursing schools across the United States, and they reflect on the implications of using this tool to deepen discussions around the social mission and strengthen progress toward health equity.From 2016 to 2019, the authors created and field tested the online social mission metrics survey for health professions schools to identify their level of engagement in social mission activities, track that level over time, and compare their progress with that of other schools. The survey measures a school's social mission values, programs, and activities across 6 domains and 18 activity areas. The authors also developed a scoring system based on stakeholder priorities, which they used to provide customized, confidential feedback to the schools that participated in the field tests.Going forward, the authors recommend that schools complete the survey every 3 to 5 years to track their social mission over time, and they plan to expand the survey process to additional dental, medical, and nursing schools as well as to schools in other health professions. The social mission metrics survey is meant to be a useful tool for improving the level and quality of social mission engagement at health professions schools, with the goal of improving the awareness, skills, and commitment of health professionals to health equity.

Factors Important to Top Clinical Performance in Emergency Medicine Residency: Results of an Ideation Survey and Delphi Panel.

OBJECTIVES: We explore attributes, traits, background, skills, and behavioral factors important to top clinical performance in emergency medicine (EM) residency. METHODS: We used a two-step process-an ideation survey with the Council of Emergency Medicine Residency Directors and a modified Delphi technique-to identify: 1) factors important to top performance, 2) preresidency factors that predict it, and 3) the best ways to measure it. In the Delphi, six expert educators in emergency care assessed the presence of the factors from the ideation survey results in their top clinical performers. Consensus on important factors that were exemplified in >60% of top performers were retained in three Delphi rounds as well as predictors and measures of top performance. RESULTS: The ideation survey generated 81 responses with ideas for each factor. These were combined into 89 separate factors in seven categories: attributes, personal traits, emergency department (ED)-specific skills and behaviors, general skill set, background, preresidency predictors, and ways to measure top performance. After three Delphi rounds, the panel achieved consensus on 20 factors important to top clinical performance. This included two attributes, seven traits, one general skill set, and 10 ED-specific skills and behaviors. Interview performance was considered the sole important preresidency predictor and clinical competency committee results the sole important measure of top performance. CONCLUSION: Our expert panel identified 20 factors important to top clinical performance in EM residency. Future work is needed to further explore how individuals learn and develop these factors.

Digital health technology for use in patients with serious mental illness: a systematic review of the literature.

BACKGROUND: As the capabilities and reach of technology have expanded, there is an accompanying proliferation of digital technologies developed for use in the care of patients with mental illness. The objective of this review was to systematically search published literature to identify currently available health technologies and their intended uses for patients with serious mental illness. MATERIALS AND METHODS: The Medline, Embase, and BIOSIS Previews electronic databases were searched to identify peer-reviewed English language articles that reported the use of digital, mobile, and other advanced technology in patients with schizophrenia/schizoaffective disorder, bipolar disorder, and major depressive disorder. Eligible studies were systematically reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Eighteen studies that met the inclusion criteria were identified. Digital health technologies (DHTs) assessed in the selected studies included mobile applications (apps), digital medicine, digital personal health records, and an electronic pill container. Smartphone apps accounted for the largest share of DHTs. The intended uses of DHTs could be broadly classified as monitoring to gain a better understanding of illness, clinical assessment, and intervention. Overall, studies indicated high usability/feasibility and efficacy/effectiveness, with several reporting validity against established clinical scales. Users were generally engaged with the DHT, and mobile assessments were deemed helpful in monitoring disease symptoms. CONCLUSION: Rapidly proliferating digital technologies seem to be feasible for short-term use in patients with serious mental illness; nevertheless, long-term effectiveness data from naturalistic studies will help demonstrate their usefulness and facilitate their adoption and integration into the mental health-care system.