Building New York State Centers of Excellence in Children's Environmental Health: A Replicable Model in a Time of Uncertainty.

Public health programs may be seriously affected in periods of federal retrenchment. During these times, state-based strategies provide an alternate pathway for advancing public health.A 12-year campaign to secure state support for a network of Centers of Excellence in Children's Environmental Health (CEH) promoting health of children across New York State is described. It was driven by rising rates of asthma, birth defects, developmental disorders, and other noncommunicable diseases in children; growing evidence associating hazardous environmental exposures with these conditions; and recognition that federal resources in CEH are insufficient.Critical campaign elements were (1) formation of a statewide coalition of academic health centers, health care providers, public health officials, community advocates, and other stakeholders; (2) bipartisan collaborations with legislative champions and government leaders; (3) assessment of the burden of developmental disorders and noncommunicable diseases associated with environmental exposures among children; (4) maps documenting the presence of environmental hazards in every county statewide; (5) iterative charting of a changing political landscape; and (6) persistence. The 2017 award of a 5-year, $10 million contract to establish Centers of Excellence in CEH demonstrates the value of this statewide strategy.

Finding the Story.

Story is the oldest known way of sharing knowledge and information and engages us in our collective humanity. In research settings, story brings meaning to complex ideas, making them feel palpable and connects us with our audience. Historically, the disciplines that take a research interest in the importance of narrative have been largely in fields like the philosophy of science/medicine, medical humanities, and sociology though story is "always already" a part of scientific research. Humanities have gained traction in medical and science education, and researchers are seeking such curricula to communicate more effectively with the public and their students. We believe that story is an effective tool to enable CTS investigators to be effective educators and communicators of translational science. Story-based interdisciplinary pedagogy emphasizes an approach encouraging clinical researchers to keep the human story as the driving force of research design, dissemination, and application of research to diverse audiences. In this article, we provide backgrounds on successful programs that have used story in science communication and education as well as a tool researchers can use to incorporate the structure of story into their own work.

Medical Improvisation Training for all Medical Students: 3-Year Experience.

INTRODUCTION: Effective communication has been shown to improve patients' health outcomes. This study utilizes medical improvisation techniques to teach communication skills to an entire medical school class. METHODS: Required workshops were held for entering third-year students from 2005 to 2017. Workshop evaluations were obtained immediately following each session and at 3 months post-workshop for one cohort. RESULTS: Four hundred ninety-four medical students participated in the improvisation workshops. Over 90% of students rated the workshops as above average or excellent. Students reported a gain in insights regarding their role as a physician (≥ 90%), an improvement in their ability to demonstrate effective communication (80-87%), and a positive impact on teamwork (91-93%). At 3 months post-workshop, 84% of students reported they had used at least 1 improvisation skill on their clinical wards (50% response rate). CONCLUSIONS: This study demonstrates that medical improvisation exercises can be scaled to an entire class of medical students versus a self-selected group of students. Further, we found that students felt that it improved their communication. This study also provides new insights regarding specific improvisation exercises that are most useful for the clinical environment.

Teaching Medical Students to Communicate With Empathy and Clarity Using Improvisation.

PROBLEM: Medical educators widely accept that health care providers need strong communication skills. The authors sought to develop a course incorporating improvisation to teach health professions students communication skills and build empathy. APPROACH: Teaching health care professionals to communicate more effectively with patients, the public, and each other is a goal of the Alan Alda Center for Communicating Science at Stony Brook University. The authors designed an interprofessional elective for medical, nursing, and dental students that differed in several respects from traditional communication training. The Communicating Science elective, which was offered by the Alda Center from 2012 to 2016, used verbal and nonverbal exercises, role-playing, and storytelling, including improvisation exercises, to teach students to communicate with empathy and clarity. OUTCOMES: In course evaluations completed by 76 students in 2012 and 2013, 100% said they would recommend the course to fellow students, saw the relevance of the course content to their careers, and desired more of the course content in their school's curriculum. As a result of this positive feedback, from 2014 to 2016, 10 hours of instruction pairing empathy and communication training was embedded in the preclinical curriculum at the Stony Brook University School of Medicine. NEXT STEPS: This course could be an effective model, and one that other institutions could employ, for improving communication skills and empathy in the next generation of health care professionals. Next steps include advocating for communication skills training to be embedded throughout the curriculum of a four-year medical school program.

A challenging empirical question: What are the effects of media on psychogenic illness during a community crisis?

Psychogenic illness during disasters can cripple emergency healthcare services. Almost all research into this phenomenon has been retrospective and observational, and much of it suggests that media coverage can amplify psychogenic outbreaks. But there is little empirical evidence that this is true or that, conversely, media reports can mitigate psychogenic symptoms. In their work experimentally inducing psychogenic illness, the authors became sharply aware that it is difficult to experimentally mimic real-time media coverage. Yet clarifying media's effects on psychogenic illness is important if we want to prevent psychological disturbance. To meet this challenge, the authors advocate the funding and development of research protocols in advance of public emergencies, ready to be implemented in real-time. Coupled with digital media, which can track the reading and viewing behavior of millions of people, this approach can help us better understand media's impact on public health during an emergency, for better or for worse.

Experimental induction of psychogenic illness in the context of a medical event and media exposure.

OBJECTIVES: Mass psychogenic illness can be a significant problem for triage and hospital surge in disasters; however, research has been largely limited to posthoc observational reports. Reports on the impact of public media during a disaster have suggested both salutary as well as iatrogenic psychological effects. This study was designed to determine if psychogenic illness can be evoked and if media will exacerbate it in a plausible, controlled experiment among healthy community adults. METHODS: A randomized controlled experiment used a simulated biological threat and elements of social contagion--essential precipitants of mass psychogenic illness. Participants were randomly assigned to one of three groups: no-intervention control group, psychogenic illness induction group, or psychogenic illness induction plus media group. Measures included three assessments of symptom intensity, heart rate, blood pressure, as well as questionnaires to measure potential psychogenic illness risk factors. RESULTS: The two psychogenic induction groups experienced 11 times more symptoms than the control group. Psychogenic illness was observed in both men and women at rates that were not significantly different. Higher rates of lifetime history of traumatic events and depression were associated with greater induction of illness. Media was not found to exacerbate symptom onset. CONCLUSIONS: Psychogenic illness relevant to public health disasters can be evoked in an experimental setting. This sets the stage for further research on psychogenic illness and strategies for mitigation.

The environment in pediatric practice: a study of New York pediatricians' attitudes, beliefs, and practices towards children's environmental health.

Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children's health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children's health is significant (mean 4.44 +/- 0.72 on 1-5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16-4.24 +/- 0.90-1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51-3.21 +/- 0.90-1.23; p < 0.001). About 93.8% would send patients to a clinic "where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns." These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.