COVID-19: A Vaccine Priority Index Mapping Tool for Rapidly Assessing Priority Populations in North Carolina.

BACKGROUND: The initial limited supply of COVID-19 vaccine in the U.S. presented significant allocation, distribution, and delivery challenges. Information that can assist health officials, hospital administrators and other decision makers with readily identifying who and where to target vaccine resources and efforts can improve public health response. OBJECTIVE: The objective of this project was to develop a publicly available geographical information system (GIS) web mapping tool that would assist North Carolina health officials readily identify high-risk, high priority population groups and facilities in the immunization decision making process. METHODS: Publicly available data were used to identify 14 key health and socio-demographic variables and 5 differing themes (social and economic status; minority status and language; housing situation; at risk population; and health status). Vaccine priority population index (VPI) scores were created by calculating a percentile rank for each variable over each N.C. Census tract. All Census tracts (N = 2,195) values were ranked from lowest to highest (0.0 to 1.0) with a non-zero population and mapped using ArcGIS. RESULTS: The VPI tool was made publicly available (https://enchealth.org/) during the pandemic to readily assist with identifying high risk population priority areas in N.C. for the planning, distribution, and delivery of COVID-19 vaccine. DISCUSSION: While health officials may have benefitted by using the VPI tool during the pandemic, a more formal evaluation process is needed to fully assess its usefulness, functionality, and limitations. CONCLUSION: When considering COVID-19 immunization efforts, the VPI tool can serve as an added component in the decision-making process.

Initiatives for Responding to Medical Trainees' Moral Distress about End-of-Life Cases.

Moral distress frequently arises for medical trainees exposed to end-of-life cases. We review the small literature on best practices for reducing moral distress in such cases and propose two areas to target for moral distress reduction: medical education and organizational ethics programs. Students require training in end-of-life dialogues and truthful prognostication, which are not generally available without skilled mentors. But physician-mentors and teachers can suffer from lingering moral residue themselves, which can affect the teaching culture and student expectations. Finally, reducing unit moral distress that affects learners requires formal educational opportunities to debrief about difficult end-of-life cases and formal institutional mechanisms for effective clinical ethics consultation.

Profile of Public Health Leadership.

CONTEXT: Public health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies. OBJECTIVE: This research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning. DESIGN: Data were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors. RESULTS: Deans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees. CONCLUSION: The findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.

The status of interprofessional education and interprofessional prevention education in academic health centers: a national baseline study.

PURPOSE: Given the emphasis on prevention in U.S. health care reform efforts, the importance of interprofessional education (IPE) that prepares health professions students to be part of effective health care teams is greater than ever. This study examined the prevalence and nature of IPE and interprofessional (IP) prevention education in U.S. academic health centers. METHOD: The authors extracted a 10-item survey from the longer published IPE Assessment and Planning Instrument. In September 2010, they sent the survey to 346 health professions leaders in health sciences schools and colleges at 100 academic health centers. These institutions were identified via the online membership list of the Association of Academic Health Centers. The authors conducted descriptive statistical analysis and cross-tabulations. RESULTS: Surveys were completed by 127 contacts at 68 universities in 31 states and the District of Columbia. IPE was more prevalent than IP prevention education in all categories of measurement. Respondents affirmed existence of IPE in courses (85.0%) and in clinical rotations/internships (80.3%). The majority reported personnel with responsibility for IPE (68.5%) or prevention education (59.8%) at their institutional unit, and 59.8% reported an IPE office or center. CONCLUSIONS: This study provides evidence that IPE and IP prevention education exist in academic health centers, but additional attention should be paid to the development of IP prevention education. Sample syllabi, job descriptions, and policies may be available to support adoption of IPE and IP prevention education. Further effort is needed to increase the integration of IP and prevention education into practice.

Qualitative assessment of agritourism safety guidelines: a demonstration project.

In 2007, the National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS) published Agritourism Health and Safety Guidelines for Children to provide helpful recommendations for protecting the health and safety of children visiting agritourism farms. Supplement A: Policies and Procedures Guide and Supplement B: Worksite Guide were subsequently published in 2009 and provided agritourism farms with checklists to use in reviewing, planning, and implementing their own health and safety practices. In order to better understand what would be required of a farm wishing to implement the guidelines using Supplements A and B, the North Carolina Agromedicine Institute conducted a single-family farm demonstration project with support from the NCCRAHS. The aims of the project were to (1) determine child health and safety risks associated with an existing agritourism farm; (2) determine the cost of making improvements necessary to reduce risks; and (3) use project findings to motivate other agritourism farms, Cooperative Extension agents, and agritourism insurers to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work. At the conclusion of the study, the target farm was in compliance with an average of 86.9% of items in Supplements A and B. Furthermore, 89% of individuals self-identifying as farmers or farm workers and 100% of Cooperative Extension agents and agritourism insurers attending an end-of-project workshop indicated their intent to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work.

Using clinical skills exams to evaluate medical student skills in prevention.

BACKGROUND: In 2006, the Brody School of Medicine Regional Medicine-Public Health Education Center integrated the teaching of prevention into the curriculum for first-, second-, and third-year medical students. PURPOSE: The purpose of this article is to report on the use of clinical skills exams (CSEs) in the evaluation of prevention health instruction for the period 2006-2010. METHODS: Two CSEs were employed to measure preventive skills at the end of the third year of medical school. CSE-1 was a woman aged 56 years with knee pain. The outcome measure is the percentage of students asking three or more prevention history items. CSE-2 was a boy, aged 15 years, undergoing a sports physical/preventive screening. The outcome measure is the number of prevention items queried. RESULTS: For CSE-1, the percentage of students who met the outcome measure increased to 83% in 2010 as compared to 62% in both 2009 and 2007. The improvement between 2007 and 2010 was significant with a p=0.0080 (Fisher's exact test). Of the 64 students taking the third-year medical student objective structured clinical examination-2 in June 2009, the greatest number queried the following preventive items: exercise (98%), alcohol misuse (98%), drug use (98%), school and grades (98%), sexual activity (98%), and tobacco use (97%). CONCLUSIONS: By integrating prevention elements into CSE cases, the results are useful for student assessment and may be a powerful influence on curricular design, leading to an increase in prevention content.

Effect of educational interventions and medical school policies on medical students' attitudes toward pharmaceutical marketing practices: a multi-institutional study.

PURPOSE: To determine the effect of educational interventions on medical students' attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions. METHOD: Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S. medical schools. Intervention students experienced a former pharmaceutical representative's presentation, faculty debate, and a Web-based course. Both groups completed baseline and follow-up attitude surveys about pharmaceutical marketing. RESULTS: A total of 482 students (51.6%) completed both surveys. In regression analyses, intervention students were more likely than control students to think that physicians are strongly or moderately influenced by pharmaceutical marketing (OR, 2.29; 95% CI, 1.46-3.59) and believed they would be more likely to prescribe a company's drug if they accepted that company's gifts and food (OR, 1.68; 95% CI, 1.12-2.52). Intervention students were more likely to support banning interactions between pharmaceutical representatives and students (OR, 4.82; 95% CI, 3.02-7.68) and with physicians (OR, 6.88; 95% CI, 4.04-11.70). Students from schools with more restrictive policies were more likely to support banning interactions between pharmaceutical representatives and students (OR, 1.99; 95% CI, 1.26-3.16) and with physicians (OR, 3.44; 95% CI, 2.05-5.79). CONCLUSIONS: Education about pharmaceutical marketing practices and more restrictive policies governing medicine-industry interactions seem to increase medical students' skepticism about the appropriateness of such marketing practices and disapproval of pharmaceutical representatives in the learning environment.

Office of Interdisciplinary Health Studies Education, East Carolina university.

The Office of Interdisciplinary Health Sciences Education resides organizationally within East Carolina University (ECU), Division of Health Sciences; ECU established this office in 1999. The mission of the office is fivefold: 1. promote the expansion of interdisciplinary training within and between Health Sciences and other health-related programs on campus; 2. promote innovative research opportunities across disciplines, in particular, projects regarding interdisciplinary health sciences education; 3. serve as a clearinghouse for information relative to existing and planned interdisciplinary activities and projects within the Division; 4. collaborate with units, and communities in establishing community partnerships for interdisciplinary rural health training; and 5. identify core curricular content across health-related disciplines, minimizing curricular redundancy while promoting interdisciplinary collaboration.

Interprofessional education assessment and planning instrument for academic institutions.

This article describes the creation, development, and peer review of an instrument for the assessment and improvement of interprofessional health educational programs in public and private health educational institutions nationally and internationally. The self-assessment is constructed with consideration of the following domains: educational venues, educational evaluation, programmatic participation, institutional support, and faculty incentives. The interprofessional education assessment and planning instrument for academic institutions can be a major aide in helping national and international leaders promoting IPE as the method to prepare future health professionals.

Learner-centered characteristics of nurse educators.

The purpose of this study was to describe the learner-centered teaching characteristics of nurse faculty who report using contemporary pedagogy. A secondary analysis of data collected by an international survey of nurse educators regarding pedagogical teaching approaches and strategies was used to answer the research questions. The study sought to: 1) describe characteristics emerging from faculty response, 2) make inferences from faculty responses regarding meaning, and 3) make inferences regarding the importance of the meaning to nursing. A qualitative research design was used to address the research question. Themes that emerged were placed under the concepts of power, role of teacher, responsibility of learner, and philosophy of evaluation guided by Weimer's (2002) conceptual framework of a learner-centered philosophy of teaching. Themes and meaning units derived from the study helped to generate textual and structure statements that represent the characterizations of learner-centered nurse educators.

Hands on learning: the use of simulated clients in intervention cases.

Standardized patients assist with the education of medical, physical therapy and nursing students. However, the literature does not discuss the use of these learning experiences with occupational therapy students. This article describes the use of standardized clients in a simulation learning experiences and the responses of occupational therapy students to the instructional modality. Qualitative data was analyzed and resulted in the following themes: "I felt like a therapist," "I integrated knowledge and applied my skills with the help of my partner," and "The experience could be enhanced." On a survey, students rated the live simulated learning experience higher than all other instructional methods presented. Included are recommendations for structuring activities using simulated clients and future research.

Leadership styles in interdisciplinary health science education.

The US Institute of Medicine recommends that all health professionals should deliver patient-centered care as members of interdisciplinary health science teams. The current application of the Bolman and Deal Leadership model to health sciences provides an interesting point of reference to compare leadership styles. This article reviews several applications of that model within academic health care and the aggregate recommendations for leaders of health care disciplines based on collective findings.

Descriptive meta-evaluation. Case study of an interdisciplinary curriculum.

This article describes an example of meta-evaluation in an educational setting. The meta-evaluation examined an evaluation of a community-based, interdisciplinary curriculum. The Program Evaluation Standards (PES), divided into the categories of utility, feasibility, propriety, and accuracy, provided a framework for the meta-evaluation. Utility standards address the information needs of intended users. Feasibility refers to the extent to which an evaluation is realistic, prudent, diplomatic, and frugal. Propriety refers to the properness of an evaluation in terms of meeting legal and ethical obligations. Accuracy pertains to the trustworthiness of evaluation data. Use of the PES as a framework for descriptive meta-evaluation of a single case illustrated the breadth of issues involved in curriculum evaluation and their interrelatedness. Furthermore, the PES helped to reveal strengths and weaknesses that served as starting points for further improvement of the evaluation.

Reflections on integrating theories of adult education into a medical school faculty development course.

The purpose of this study was to test a three-day course model for medical school faculty designed to promote self-directed learning, teaching skills, personal awareness and interdisciplinary collegiality. The training program described was conducted three times in our medical school. Fifty-eight faculty from 11 clinical departments have participated in this intensive experience of learning how to teach, based on principles of learner-centered learning and adult education theory. Participants defined their own learning objectives and worked collaboratively in facilitated small groups to develop teaching skills. Reflection groups engaged in discussion on critical incidents of experience as teachers and learners, and promoted awareness regarding personal approaches to teaching. Qualitative and quantitative data showed that the course was effective in: (1) providing an academically and emotionally safe environment for learning; (2) enabling participants to recognize and value learner-centered learning; (3) increasing participant personal awareness, and (4) promoting interdisciplinary collegiality. End-of-course data assessing the following course attributes, using a five-point scale, where 1 was 'not effective' and 5 was 'very effective', showed: (a) exploration of needs: mean 4.20 +/- SD 0.91; (b) interactive sharing of ideas; mean 4.60 +/- SD 0.58; (c) opportunity to receive feedback: mean 4.26 +/- SD 0.80; (d) opportunity to practice new skills; mean 4.11 +/- SD 0.72. In terms of participation in further faculty development, 92% of participants committed themselves to continue the work begun at the course. It was concluded that the faculty development program created a safe, learner-centered environment for participants that promoted both awareness of and commitment to self-directed learning, and facilitated teaching skill development and interdisciplinary collegiality. Our three-day course appears to be highly effective in initiating a long-term faculty development process. Additionally, we conclude that there is a need for longitudinal follow-up to support and expand mastery of these teaching skills.