Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators.

ISSUE: The framework of cultural humility, which emphasizes curiosity and self-reflection over mastery, was identified over 20 years ago as a way to address implicit bias in health care, an important factor in health disparities. Despite growing interest from researchers and educators, as well as the urgent call to adopt these values, the foundational elements of cultural humility remain challenging to teach in medical education and have not yet been widely adopted. EVIDENCE: Health disparities persist throughout the United States among a growing population of diverse patients. The cultural humility framework undermines power imbalances by encouraging the clinician to view their patient as an expert of their own experience. This approach strengthens relationships within the community, illuminates racial and historical injustices, and contributes to equitable care. However, recent reviews have shown that humility-based principles have yet to be widely integrated into cultural curricula. Based on available evidence, this article introduces the foundational concepts of cultural humility with the aim of helping medical educators better understand and implement the principles of cultural humility into undergraduate medical education. IMPLICATIONS: Cultural humility is a powerful and feasible adjunct to help student physicians cultivate effective tools to provide the best patient care possible to an increasingly diverse patient population. However, there is little known about how best to implement the principles of cultural humility into existing undergraduate medical education curricula. The analyses and strategies presented provide educators with the background, instructional and curricular methods to enable learners to cultivate cultural humility. Future systematic research will need to focus on investigating design, implementation and impact.

Cost of deep brain stimulation for the treatment of Parkinson's disease by surgical stimulation sites.

OBJECTIVE: To assess costs and effectiveness of deep brain stimulation (DBS) of the internal globus pallidum (GPi) versus subthalamic nucleus (STN) from the provider and societal perspectives for Parkinson's disease (PD) patients in a multicenter randomized trial. METHODS: All costs from randomization to 36 months were included. Costs were from Department of Veterans Affairs (VA) and Medicare databases and clinical trial data. Quality adjusted life years (QALYs) were from Quality of Well Being questionnaires. RESULTS: Provider costs were similar for the 144 GPi and 130 STN patients (GPi: $138,044 vs. STN: $131,822; difference = $6,222, 95% confidence interval [CI]: -$42,125 to $45,343). Societal costs were also similar (GPi: $171,061 vs. STN: $167,706; difference = $3,356, 95% CI: -$57,371 to $60,294). The GPi patients had nonsignificantly more QALYs. CONCLUSIONS: The QALYs and costs were similar; the level of uncertainty given the sample size suggests that these factors should not direct treatment or resource allocation decisions in selecting or making available either procedure for eligible PD patients.

Spirituality, self-compassion, and anxiety among sexual minority men: a longitudinal mediation analysis.

BACKGROUND AND OBJECTIVE: Research related to anxiety among sexual minority men (SMM) typically focuses on risk factors. It has seldom examined factors that may be associated with lower levels of anxiety. This gap in the literature represents an opportunity to explore positive psychological factors that may be related to lower levels of anxiety among this group. Spirituality and self-compassion are two positive psychological factors that have been associated with reduced anxiety in general samples but have been understudied among SMM. This study aimed to determine the longitudinal associations between spirituality, self-compassion, and anxiety. DESIGN AND METHODS: Guided by an Afrocentric psychological framework, we conducted a secondary quantitative analysis with data from a racially and ethnically diverse sample of 697 U.S. SMM. RESULTS: Utilizing Hayes PROCESS Macro Model 4, we found that spirituality at baseline was positively associated with self-compassion at baseline, which in turn was inversely associated with anxiety at 12-month follow-up. CONCLUSIONS: Overall, our findings provide evidence that spirituality and self-compassion are two positive psychological factors that are inversely associated with anxiety among SMM.

Accessibility and feasibility of using technology to support mindfulness practice, reduce stress and promote long term mental health.

BACKGROUND AND PURPOSE: We evaluated the feasibility of using an activity monitor to support mindfulness practice, reduce self-reported stress and physiological indicators of stress. MATERIALS AND METHODS: Adult women (N = 19) who previously participated in a mindfulness intervention wore an activity monitor for eight-weeks. The activity monitor notified them when they were stressed (based on standard deviation pulse pressure). Heart rate and pulse pressure were continuously collected via the activity monitor. Mindfulness, stress, depression and trauma symptoms were collected via self-report surveys. RESULTS: There were no significant changes in self-reported stress, depression, post-traumatic stress and mindfulness from baseline to eight-weeks. Pulse pressure and standard deviation of pulse pressure increased over time. Those who were high on the non-judge mindfulness subscale had a lower standard deviation pulse pressure and spent less time stressed. CONCLUSION: Those who are more mindful are less likely to have physiological signs of stress.

Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center.

BACKGROUND: In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC). METHODS: Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks. RESULTS: Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05). CONCLUSIONS: Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.

Psychotherapy utilization for acute depression within the Veterans Affairs health care system.

This study examined the demographic characteristics and psychiatric comorbidities associated with the receipt of psychotherapy. The sample included 217,816 VA patients with a new depression diagnosis. Multinomial logistic regression analyses examined the relationships between the independent variables and the initiation of individual, group, or both individual and group psychotherapy within 90 days of a new diagnosis. Eighteen percent of VA patients received some form of psychotherapy. Veterans received a greater mean number of group therapy than individual therapy visits. Veterans who were female, younger than 35, unmarried, and with substance use, anxiety, or personality disorders were more likely to receive individual therapy only. Veterans who were male, 35-49 years old, Black, Other, or Hispanic, and with substance-use or anxiety disorders were more likely to receive group therapy only than no psychotherapy. Veterans who were male, 35-49 years old, Black, or Other race and with substance-use or anxiety disorders were more likely to receive both individual and group psychotherapy. Increased efforts are needed to encourage early initiation of psychotherapy treatment among depressed veterans.