Perspective: Acknowledging a Hierarchy of Social Needs in Diabetes Clinical Care and Prevention.

The evidence of suboptimal social determinants of health (SDoH) on poor health outcomes has resulted in widespread calls for research to identify ways to measure and address social needs to improve health outcomes and reduce disparities. While assessing SDoH has become increasingly important in diabetes care and prevention research, little guidance has been offered on how to address suboptimal determinants in diabetes-related clinical care, prevention efforts, medical education and research. Not surprisingly, many patients experience multiple social needs - some that are more urgent (housing) than others (transportation/resources), therefore the order in which these needs are addressed needs to be considered in the context of diabetes care/outcomes. Here we discuss how conceptualizing diabetes related health through the lens of Maslow's hierarchy of needs has potential to help prioritize individual social needs that should be addressed to improve outcomes in the context of population-level determinants in the communities where people live.

Peer observation of teaching: A feasible and effective method of physician faculty development.

Physician faculty learn teaching skills informally while fighting competing professional obligations. One underutilized proven technique to improve teaching skills is peer observation with feedback. We aimed to understand benefits and challenges of a physician faculty development program based on peer observation of teaching and to develop best practice recommendations for future program development. The authors developed a peer observation-based physician faculty development program from 2015 to 2017. Two interviewers conducted and analyzed qualitative interviews with 13 faculty participants and four non-participants using content analysis to identify themes and subthemes in NVivo©. Participant-identified program benefits included conveyed institutional support for teaching, the opportunity for peer observation with direct and timely feedback, the opportunity for community building, and overall program feasibility. Program challenges included competing scheduling demands, variability in feedback quality, and difficulty maintaining engagement for the program duration. Potential areas for improvement included participation incentives, external faculty involvement, assistance with program logistics and administration, and improvement in the consistency of the feedback experience. While peer observation is a valued approach to physician faculty development of teaching skills, competing demands on physicians may still limit program effectiveness. Program sustainability depends on optimizing feedback quality, boosting motivation for participation, and providing administrative support.

Cooking demonstrations to teach nutrition counseling and social determinants of health.

Background: Future physicians should feel comfortable educating patients on disease-specific diets, and culinary medicine is an innovative approach to preparing medical students for this task. We present an engaged-learning program where medical students give community cooking demonstrations to gain experience counseling adults on nutrition and simultaneously develop understanding of the social determinants of health. Student volunteers undergo training in culinary skills, nutrition, motivational interviewing, and social determinants of health. They then lead cooking demonstrations at a local farmers' market and later participate in a group debriefing session with faculty. Methods: Postexperience surveys were obtained. The primary outcome evaluated was feasibility of this educational intervention. Secondary outcomes were (1) student perception of the value of the program and (2) student self-rated learning of nutrition science, nutrition education, and social determinants of health. Results: A total of 117 students participated in the program over 3 years and 57% answered the postexperience survey. Students filled 91% of available volunteer slots (79 first-, 26 second-, 3 third-, and 9 fourth-year students). In a postexperience survey, 94.7% responded that the experience resulted in learning about nutrition education and 82.4% reported learning about social determinants of health. In commentary, students note that medical education was enhanced by interacting with community members. Discussion: Culinary education in a community setting is a feasible medical school service-learning activity that is well received by students. It can enhance learning of nutrition counseling skills and improve student understanding of the social determinants of health.

Predictors of Student Engagement in Learning Communities.

INTRODUCTION: Little is known about what factors predict student engagement in learning communities (LCs). At our institution, we recently converted from an informal, unfunded program with volunteer mentors and no participation requirement to a formal, funded program with a structured curriculum, dedicated mentors, and required attendance. We sought to identify factors that predict student engagement in this new program. METHODS: Medical students from all 4 years were invited to complete a survey that included self-rating of their level of engagement with their LC. We hypothesized that student engagement would be (1) higher in the new, formal program compared with the informal program; (2) lower among older students; and (3) higher among students who value collective activities for stress management. RESULTS: In total, 75% of students completed the survey. Students who participated in the formal LC program reported significantly higher engagement than those who experienced the informal version. Older, out-of-state, and underrepresented in medicine (URiM) students reported lower levels of engagement compared with younger, in-state, and non-URiM students, but gender and campus assignment were not associated with level of engagement. Students who valued participation in extracurricular activities, service work, and time with friends or family all had higher levels of engagement in LCs compared with those who valued more solitary activities. DISCUSSION: The formal, structured LC program was associated with higher levels of engagement than the informal program, and engagement was maintained throughout the 4-year curriculum. Subgroups of students reported lower engagement in LCs, and future research is needed to better understand and address this variability in engagement. This study is limited by the fact that students are only surveyed once annually, at a single institution, and our measure of engagement is brief and dependent on student self-report. In addition, it is not possible to discern from this study which components of the formal LC program were most strongly associated with high engagement.

Perceived Benefits of a Peer Mentoring Program for First-Year Medical Students.

Problem: Peer mentoring has long been accepted as beneficial in a multitude of fields, but there has been limited description or study of the way these types of relationships may benefit medical students. Peer mentoring may be helpful for 1st-year medical students; however, little evidence is thus far available on which aspects of peer mentoring provide benefit and what those specific benefits are. Intervention: This study examines the perceived benefits and satisfaction derived by 1st-year medical students from participation in a semi-structured, informal cross-year peer mentoring program. It further attempts to characterize the aspects of peer mentoring relationships that are seen as beneficial to 1st-year students. Data were collected on demographic information, frequency and type of contact with mentor, perception of mentor characteristics, perceived benefits derived from the relationship, and their overall satisfaction with the relationship. Context: First-year medical students at a large academic institution were surveyed on their experience in an informal peer-mentoring program with 2nd-year students serving as mentors. Mentors had minimal training. No mandatory agenda or limitations were placed on the type or subject matter of interactions. Outcome: Mean overall satisfaction with the peer mentoring program was 7.47 (SD = 2.45) on a rating scale where 10 is the most satisfied. Students reported that their peer mentors generally exhibited beneficial attributes and behaviors. Ratings of perceived benefits were somewhat more variable and generally lower. Predictors of four outcomes-overall satisfaction, perceived academic benefit, perceived nonacademic benefit, and perceived clinical benefit-were explored using stepwise linear regression with forward entry and backward elimination to retain the most parsimonious model. Expertise in areas of mentee need was a consistent predictor of all outcomes. Regular involvement with a mentor was a consistent predictor of perceived academic and nonacademic benefit. Demographic characteristics were generally not predictive of outcomes. Lessons Learned: Peer mentoring is perceived by 1st-year medical students to provide psychosocial and academic benefits that appear to be independent of and complementary to those derived from faculty mentoring. These benefits can be established with minimal expenditure of institutional resources. Peer mentoring efficacy may be increased by more deliberate matching methods and by training mentors in provision of guidance and feedback, though further study is needed.

The interprofessional clinical experience: interprofessional education in the nursing home.

The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees' perception of potential team members' roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.

Exploring the affective dimension of the life review process: Facilitators' interactional strategies for fostering personhood and social value among older adults with early dementia.

We employed an auto-ethnography approach to explore the affective dimension of life review sessions with community-dwelling older military veterans with minor cognitive impairment (MCI) and early dementia. Using researchers' analytic memos, we identified facilitators' interactional strategies that fostered the participant's sense of personal identity, dignity and social self-worth. Interaction among participant, caregiver, and facilitators evoked a range of emotional responses, offering a window into the affective world of MCI and early dementia. Positive emotional responses outnumbered negative emotional responses by a ratio of two-to-one in the life review sessions; however, negative emotions were more revelatory of current struggles with declines in health and function. Facilitators utilized two interactional strategies, in particular, to foster personhood and social value of participants: focusing on the participant and creating an empathic connection with the participant. Further work is needed to understand the role of emotions in research interactions and to examine the psychosocial mechanisms through which positive affect functions in promoting identity, personhood and social value among persons with MCI and early dementia.

Normal cognitive aging.

Even those who do not experience dementia or mild cognitive impairment may experience subtle cognitive changes associated with aging. Normal cognitive changes can affect an older adult's everyday function and quality of life, and a better understanding of this process may help clinicians distinguish normal from disease states. This article describes the neurocognitive changes observed in normal aging, followed by a description of the structural and functional alterations seen in aging brains. Practical implications of normal cognitive aging are then discussed, followed by a discussion of what is known about factors that may mitigate age-associated cognitive decline.

Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting.

Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions. Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE) to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced program revisions.

Geriatric dizziness: evolving diagnostic and therapeutic approaches for the emergency department.

Dizziness affects one in five people over the age of 65 years and is associated with substantial healthcare costs. Serious causes of dizziness are found in 20% of patients over 50 years. The approach to the patient with dizziness is challenging as physical exam and diagnostic tests have suboptimal sensitivities. The risk of vascular events is higher in the first 30 days than after, suggesting some missed diagnoses. Medications and vestibular rehabilitation may serve as treatment options for dizziness, but data on their efficacy in older patients is lacking.