scholarly journals Supported rural pre-medicine: a descriptive evaluation of a novel undergraduate program’s first cohorts

2021 ◽  
Author(s):  
Sara McEwen ◽  
Takaia Larsen ◽  
Elizabeth Lund ◽  
Jonathan Vanderhoek
Keyword(s):  
Health Disparities ◽  
Medical School ◽  
Rural Health ◽  
Program Improvement ◽  
Health Science ◽  
Preliminary Evaluation ◽  
Rural Healthcare

Implication Statement Selkirk College’s Rural Pre-Medicine (RPM) program launched in 2014 as a unique undergraduate initiative designed to increase the number of students who prepare for future careers in rural healthcare and, in the longterm, to play a role in reducing rural health disparities. Preliminary evaluation indicates most students in the program have rural backgrounds and the majority of graduates with follow-up data go on to further health science programming, including medical school. Challenges with retention have been identified. RPM is committed to ongoing program improvement and to providing a model for similar programs in other jurisdictions. 

scholarly journals Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities

2020 ◽  
Vol 27 (11) ◽  
pp. 1816-1818 ◽  
Author(s):  
Kelly A Hirko ◽  
Jean M Kerver ◽  
Sabrina Ford ◽  
Chelsea Szafranski ◽  
John Beckett ◽  
...  
Keyword(s):  
Health Disparities ◽  
Rural Communities ◽  
Rural Health ◽  
Social Isolation ◽  
Healthcare System ◽  
Healthcare Access ◽  
Digital Technologies ◽  
Rural Healthcare ◽  
Social Distancing ◽  
Hospital Systems

Abstract Telehealth programs have long held promise for addressing rural health disparities perpetuated by inadequate healthcare access. The COVID-19 (coronavirus disease 2019) pandemic and accompanying social distancing measures have hastened the implementation of telehealth programs in hospital systems around the globe. Here, we provide specific examples of telehealth efforts that have been implemented in a large rural healthcare system in response to the pandemic, and further describe how the massive shift to telehealth and reliance on virtual connections in these times of social isolation may impact rural health disparities for those without access to necessary broadband to deploy digital technologies. Finally, we provide recommendations for researchers and policymakers to ensure that telehealth initiatives do not amplify existing health disparities experienced by those living in rural communities.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

Why a Consideration of Race is Important to Medical School Admissions

2021 ◽  
Vol 49 (2) ◽  
pp. 181-189
Author(s):  
Nancy L. Zisk
Keyword(s):  
Health Disparities ◽  
Medical School ◽  
People Of Color ◽  
Minority Population ◽  
Medical School Admissions ◽  
Lack Of Physicians

AbstractThe tremendous toll that COVID-19 has taken on this country’s minority population is the most recent reminder of the health disparities between people of color and people who classify themselves as white. There are many reasons for these disparities, but one that gets less attention than it deserves is the lack of physicians of color available to treat patients of color.

scholarly journals Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

2010 ◽  
Vol 2 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Colleen Y. Colbert ◽  
Curtis Mirkes ◽  
Paul E. Ogden ◽  
Mary Elizabeth Herring ◽  
Christian Cable ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical School ◽  
Advance Directives ◽  
Advance Directive ◽  
Residency Program ◽  
Health Science ◽  
Science Center ◽  
Sufficient Knowledge ◽  
Significant Difference ◽  
School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

scholarly journals Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Susan Michaels-Strasser ◽  
Paul W. Thurman ◽  
Narcisse Mwinkeu Kasongo ◽  
Daniel Kapenda ◽  
John Ngulefac ◽  
...  
Keyword(s):  
Nursing Students ◽  
Rural Health ◽  
Nursing Student ◽  
Democratic Republic ◽  
Nursing Schools ◽  
Student Interest ◽  
Columbia University ◽  
Rural Healthcare ◽  
Republic Of The Congo ◽  
Rural Sites

Abstract Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.

scholarly journals Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students

2021 ◽  
Author(s):  
Allison Yu ◽  
Michael Wilkes ◽  
Ana-Maria Iosif ◽  
Margaret Rea ◽  
Alice Fisher ◽  
...  
Keyword(s):  
Health Science ◽  
Health Profession ◽  
First Year ◽  
Linear Regression Models ◽  
Online Questionnaire ◽  
Student Stress ◽  
School Of Nursing ◽  
Resilience Scale ◽  
Related Stress

Abstract Objective Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. Methods Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. Results Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were “extremely” or “very” concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). Conclusions Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

scholarly journals Effectiveness and economic impact of a diabetes education program among adults with type 2 diabetes in South Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew Lee Smith ◽  
Lixian Zhong ◽  
Shinduk Lee ◽  
Samuel D. Towne ◽  
Marcia G. Ory
Keyword(s):  
Type 2 Diabetes ◽  
Health Disparities ◽  
Education Program ◽  
Hemoglobin A1c ◽  
Diabetes Education ◽  
Cost Savings ◽  
South Texas ◽  
Outcome Variable

Abstract Background The long-term growth and sustained high prevalence of obesity in the US is likely to increase the burden of Type 2 diabetes. Hispanic individuals are particularly burdened by a larger share of diabetes than non-Hispanic White individuals. Given the existing health disparities facing this population, we aimed to examine the effectiveness and potential cost savings of the Diabetes Education Program (DEP) offered as part of Healthy South Texas, a state-legislated initiative to reduce health disparities in 27 counties in South Texas with a high proportion of Hispanic adults. Methods DEP is an 8-h interactive workshop taught in English and Spanish. After the workshop, participants receive quarterly biometric screenings and continuing education with a health educator for one year. Data were analyzed from 3859 DEP participants with Type 2 diabetes living in South Texas at five time points (baseline, 3-months, 6-months, 9-months, 12-months). The primary outcome variable of interest for study analyses was A1c. A series of independent sample t-tests and linear mixed-model regression analyses were used to identify changes over time. Two methods were then applied to estimate healthcare costs savings associated with A1c reductions among participants. Results The majority of participants were ages 45–64 years (58%), female (60%), Hispanic (66%), and had a high school education or less (75%). At baseline, the average hemoglobin A1c was 8.57%. The most substantial reductions in hemoglobin A1c were identified from baseline to 3-month follow-up (P < 0.001); however, the reduction in A1c remained significant from baseline to 12-month follow-up (P < 0.001). The healthcare cost savings associated with improved A1c for the program was estimated to be between $5.3 to $5.6 million over a two to three year period. Conclusion Findings support the effectiveness of DEP with ongoing follow-up for sustained diabetes risk management. While such interventions foster clinical-community collaboration and can improve patient adherence to recommended lifestyle behaviors, opportunities exist to complement DEP with other resources and services to enhance program benefits. Policy makers and other key stakeholders can assess the lessons learned in this effort to tailor and expand similar initiatives to potentially at-risk populations. Trial registration This community-based intervention is not considered a trial by ICMJE definitions, and has not be registered as such.

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