Intimate Partner Violence (IPV) as a Public Health Crisis: A Discussion of Intersectionality and Its Role in Better Health Outcomes for Immigrant Women in the United States (US).

Much of current work in providing care for intimate partner violence (IPV) in the United States (US) is centered around screening female patients. There is minimal work to tailor screening of IPV to marginalized patient populations such as immigrant women. This discussion explores the need for non-stigmatizing, intersectional perspective in medicine, especially in working with diverse immigrant populations and in facing the public health crisis of IPV. We explore the needs in our healthcare education and practice for intersectionality. By understanding the need for intersectionality, current best practices in IPV screening, and operationalizing of such perspectives and practices, we draw attention to healthcare needs for immigrant women and aim to increase understanding of IPV in medical education.

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study.

Direct primary care (DPC) is a growing model of care that is suggested as an alternative to traditional fee-for-service healthcare. Patient-reported experiences of DPC can provide unique insight into the impact of joining the model and inform quality improvement. The purpose of this study was to investigate patient perceptions of DPC. Thirty-one participants were initially recruited for the study and completed a survey assessing patient demographics. Of the 31 participants, 10 went on to complete the focus group interviews. Qualitative analysis of focus group transcripts identified common themes and subthemes. Focus group findings were stratified into 4 themes including quality of care, access to care, affordability, physician qualities, and reasons for choosing DPC. The top positive subthemes were good communication, joining DPC due to poor past healthcare experiences, and physician personability. The most common negative subthemes were difficulty referring to specialists outside the practice, poor communication, and poor access to medications. All findings were presented and discussed with the investigated clinic to facilitate improvements in healthcare delivery.

Promoting Physician Diversity through Medical Student Led Outreach and Pipeline Programs.

INTRODUCTION: Current projections anticipate a dramatic shift from historical population demographics in the United States. Racial and ethnic minorities are expected to constitute the majority of the population by 2050. However, racial minorities continue to be underrepresented in medical school admissions and the physician workforce. Creating a medical student and physician workforce that reflects population demographics of their patients will be an important determinant in promoting public health and health equity. METHODS: Medical student led educational outreach programming targeting middle and high school students is one way by which current medical students can actively work to systematically address barriers to aspiring URiM medical students. RESULTS: Opportunities for medical students to implement meaningful educational outreach programming are limited only by personal motivation and institutional support. Implementation of these programs would provide college and medical school candidacy support for aspiring medical students while providing personal development and education benefits to medical students implementing the program. CONCLUSION: The authors call on medical students across the country to join in pursuit of health equity and a diverse physician workforce that reflects the evolving demographics of the United States. Medical students can impact the health of local communities through implementation of educational outreach programming to facilitate access to medical education for middle and high school students.

Self-Perceived Independent Living Skills and Self-Determination as a Method of Evaluating a Residential Program in Young Adults With Autism Spectrum Disorder.

Prior research shows that employment programs for individuals with autism spectrum disorder (ASD) fail to address ASD as a heterogeneous disorder and focus on specific ASD traits associated with difficulty in obtaining and maintaining employment. This study provides descriptive evidence that self-perceptions of self-determination improve in young adults with ASD who participate in a residential program that promotes Wehmeyer and Schalock's essential characteristics of self-determined behavior: behavioral autonomy, self-regulated behavior, acting in a psychologically empowered manner, and self-realization. Qualitative surveys were administered to 60 participants (17-28 years old) on perceptions of self-determination, confidence in independent living skills, and program effectiveness regarding case management and sustainable employment. One-sided t-tests using pre- and post-program responses were assessed. Post- versus pre-program means were significantly higher in participants feeling confident to live alone (p = 0.0059). Findings suggest that programs adopting self-determined behavior may be more effective in increasing self-confidence for individuals with ASD. However, these findings warrant long-term analysis to assess the continuity of program success and sustained employment.

Creating a Pipeline for Minority Physicians: Medical-Student-Led Programming.

Medical School Outreach Programming provides value to medical schools and the community by: (1) fulfilling medical school accreditation requirements, (2) creating pipelines to promote diversity in future healthcare professionals, and (3) providing medical students with opportunities for extracurricular community-level engagement. An Outreach Program initiated at a U.S. community-based medical school provides a medical student-led model with primary goals of improving college candidacy and healthcare career representation for underserved and under-represented minorities in the United States. The Outreach Program also promotes the personal growth and education of medical students.

Is Community-engaged Learning Possible During a Pandemic: A Call for Culturally Competent Medical Education.

This article was migrated. The article was marked as recommended. Previously, medical school curriculum focused on faculty or physician-led basic science and traditional clinical experiences, with medical students only gaining experience of the community in which they practice during residency. In an effort to enable students to understand US healthcare disparities, the introduction of public health topics regarding marginalized communities and underrepresented individuals have been included in the classroom. However, missing from this shift is the inclusion of authentic public health educational experiences for medical students. These learning experiences are vital to truly understanding the marginalized and discriminated patient populations physicians will encounter. The recent COVID-19 pandemic has brought forth challenges for medical educators in numerous ways including how to effectively prepare students in understanding cultural competency through community-engaged learning for a new set of patient population; the pandemic patient. Due to health disparities, each patient experienced this pandemic differently based on their individual, cultural and community setting; also highlighting the importance of community-engaged learning. Here, the authors posit the role and importance of community-engaged learning in medical education and its utilization during the changing medical landscape due to COVID-19.

Investigating Social Determinants of Health in an Urban Direct Primary Care Clinic.

Direct primary care (DPC) is an emerging model of care distinguished by lower price points for quality comprehensive services. The affordability of DPC attracts a broad patient population that may encompass a wide range of socioeconomic needs. It is critical to identify social determinants of health (SDH) in DPC practices to design strategies aimed to mitigate social risk factors, especially for vulnerable populations that can only afford DPC. As part of this SDH screening initiative, the purpose of the present descriptive study was to assess the SDH characteristics of patients from an urban DPC clinic. To identify these SDH factors, a cohort of 31 patients from the DPC clinic was asked to complete a questionnaire from the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE). The survey outcomes revealed top socioeconomic needs in the domains of stress (77.4%), insurance (51.6%), social integration and support (38.7%), unmet medicine or healthcare needs (35.5%), and unemployment (32.2%). In adopting a community-based participatory research (CBPR) approach, the research team shared the survey outcomes with the DPC clinic to facilitate improvements in overall patient care and implementation of services aimed to address social risk factors as identified in the study.

Improving Health Outcomes for Immigrant Families Through IPV Screening: Resources and Recommendations for Pediatric Health Care Providers.

Intimate partner violence (IPV) is a significant yet preventable public health problem affecting 1 in 15 children annually. Children exposed to IPV exhibit lifelong consequences including increased risks of social, emotional, psychological and behavioral problems (mood and anxiety disorders, post-traumatic stress disorders, substance abuse, and school-related problems). Limited research exists in identifying and assessing gaps in IPV screening and surveillance techniques for vulnerable populations such as immigrants, refugees, or in families where English is not spoken in the home. The U.S. Department of Health and Human Services recommends IPV screening and counseling as part of pediatric office visits, without providing culturally appropriate tools for use. The nature of the patient-physician relationship and opportunities for intervention occurring during well child visits uniquely positions pediatric health care providers to identify and provide support for IPV victims and children. IPV screening should be routine, culturally appropriate, administered to all caregivers and all providers should be trained in surveilling and screening for IPV in immigrant and vulnerable populations.