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1.
Artigo em Inglês | MEDLINE | ID: mdl-38848461

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2024;26(3):23f03684. Author affiliations are listed at the end of this article.


Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Pessoas com Deficiência
4.
Trends Mol Med ; 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38734573

RESUMO

Sexual harassment in academia is endemic driven by gender-based inequalities and sustained through organizational tolerance, and its impact extends beyond the primary victim(s). Applying principles of emergency management provides a framework for institutions to balance their obligations to the primary victim(s) while also acknowledging the need to restore the well-being and culture of secondary victims.

7.
JAMA Netw Open ; 7(1): e2351046, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38198142

RESUMO

This cohort study examines the prevalence of burnout among students underrepresented in medicine by race and ethnicity with multiple disability types.


Assuntos
Esgotamento Profissional , Estudantes de Medicina , Humanos , Etnicidade , Esgotamento Psicológico
8.
JAMA Netw Open ; 6(12): e2349129, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38147338

RESUMO

This cross-sectional study investigates possible institutional and specialty variations in experiences of sexual harassment among US medical interns.


Assuntos
Internato e Residência , Assédio Sexual , Humanos , Instalações de Saúde , Educação Médica
10.
JAMA Netw Open ; 6(6): e2318310, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37314809

RESUMO

This survey study assesses self-disclosures of disability, disability types, and accommodation needs reported by US allopathic medical schools in 2021 vs 2015 and 2019.


Assuntos
COVID-19 , Estudantes de Medicina , Humanos , Prevalência , Pandemias , Faculdades de Medicina , COVID-19/epidemiologia
12.
JAMA Netw Open ; 6(5): e239981, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-37166801

RESUMO

Importance: Ensuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown. Objective: To assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations. Design, Setting, and Participants: As part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis. Main Outcomes and Measures: Prevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities. Results: Among the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]). Conclusions and Relevance: Program directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.


Assuntos
Pessoas com Deficiência , Internato e Residência , Médicos , Masculino , Humanos , Feminino , Adulto , Revelação , Estudos Longitudinais
13.
J Med Educ Curric Dev ; 10: 23821205231164022, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36936180

RESUMO

Medical students who underperform or find they are not a "good fit" for medicine have limited options. A terminal master's degree represents an exit alternative that recognizes students' completed coursework and acknowledges their commitment to the medical sciences. Although medical educators have called for the creation of such programs, termed "compassionate off-ramps," the prevalence of degree offerings in US programs is unknown. In the fall of 2020, a survey was sent to Student Affairs Deans at 141 LCME-accredited MD programs; 73 institutions responded (52%). Terminal master's degrees were offered by 19% of respondent institutions (n = 13). While 85% of those without a terminal master's (n = 48) endorsed degree benefits, only 36% (n = 21) had plans to create the degree. This study demonstrates that few US medical schools offer a terminal master's degree, leaving students who exit medicine with high levels of debt without an avenue for a degree to support employment or future academic pursuits. The authors identify implications for students, particularly those who are at a higher risk of failing Step 1, such as students who are underrepresented in medicine, socioeconomically disadvantaged, or who have a disability and are unaccommodated. Potential barriers to terminal master's program creation are identified and mitigating strategies are recommended.

14.
JAMA Intern Med ; 183(3): 269-271, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36648861

RESUMO

This study uses survey data to describe the types of sexual harassment experienced by internal medicine residents, their knowledge of reporting mechanisms, their reporting intentions and actions, and satisfaction with reporting outcomes.


Assuntos
Internato e Residência , Médicas , Assédio Sexual , Humanos , Autorrelato , Inquéritos e Questionários
15.
Med Educ ; 57(1): 102-107, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35837829

RESUMO

THE ISSUE: The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. OBSERVATIONS: Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care. APPROACH: Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. CONCLUSION: We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.


Assuntos
Educação Médica , Melhoria de Qualidade , Humanos
16.
Med Educ ; 57(6): 523-534, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36456473

RESUMO

OBJECTIVE: The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students. METHODS: The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures. RESULTS: Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]). CONCLUSIONS: Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.


Assuntos
Esgotamento Profissional , Estudantes de Medicina , Humanos , Empatia , Esgotamento Psicológico , Esgotamento Profissional/epidemiologia , Inquéritos e Questionários
18.
Health Aff (Millwood) ; 41(10): 1396-1402, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36190877

RESUMO

Physicians from underrepresented groups are at greater risk of experiencing mistreatment from coworkers and patients, including offensive remarks, physical harm, threats of physical harm, and unwanted sexual advances. These can have far-reaching negative consequences for the physicians' personal and professional lives. This study used data from a nationally representative sample of physicians to examine workplace mistreatment experienced by physicians with disabilities and determine whether physicians with disabilities are more likely to experience mistreatment in their workplace than physicians without disabilities. Compared with their nondisabled peers, physicians with disabilities had a significantly higher likelihood of experiencing every type of mistreatment from both patients and coworkers. Our findings suggest the need for disability-focused anti-mistreatment policies and practices.


Assuntos
Pessoas com Deficiência , Médicos , Humanos , Local de Trabalho
20.
PLoS One ; 17(4): e0266685, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35421144

RESUMO

INTRODUCTION: In 2019, 4.6% of US-MD students self-identified as students with disabilities (SWD); many of these students will require accommodations on the USMLE Step-1 examination. Given the high-stakes nature of Step-1 for medical school advancement and residency match, SWD denied accommodations on Step-1 face considerable consequences. To date no study has investigated the rate of accommodation denial and its impact on medical school operations. METHODS: To investigate the rate of accommodation denial and evaluate whether Step-1 accommodation denial impacts medical school operations, a 10-question survey was sent to Student Affairs Deans and disability resource professionals at all fully-accredited US-MD granting programs. Two open-ended questions were analyzed using qualitative content analysis. RESULTS: Seventy-three of the 141 schools responded (52%). In the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 (52%) were denied. Of those denied, 74/144 (51%) were delayed entry into the next phase of curriculum and 110/144 (76%) took the Step-1 exam unaccommodated. Of the 110 who took Step-1 without accommodations, 35/110 (32%) failed the exam, and 4/110 (3%) withdrew or were dismissed following exam failure. Schools reported varied investments of time and financial support for students denied accommodations, with most schools investing less than 20 hours (67%) and less than $1,000.00 (69%). Open-responses revealed details regarding the impact of denial on schools and students including frustration with process; financial and human resources allocation; delay in student progression; lack of resourcing and expertise; and emotional and financial burdens on students. DISCUSSION: Step-1 accommodation denial has non-trivial financial, operational, and career impacts on medical schools and students alike. The cause of accommodation denial in this population requires further exploration.


Assuntos
Internato e Residência , Estudantes de Medicina , Currículo , Avaliação Educacional , Humanos , Faculdades de Medicina , Estados Unidos
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