Browsing by Subject "Health Knowledge, Attitudes, Practice"
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Item The 18-Month Curriculum: The Impact of Mixed Learning Clerkships(2022-05) Kwon, Adelaide Jiwon; Sendelbach, Dorothy; Faulkner, Christopher; Tessnow, AlexBACKGROUND: UT Southwestern implemented a new, 18-month, shortened pre-clerkship curriculum in the Fall of 2015 in order to increase the clerkship phase from 1 year to 18 months, beginning mid-second year. In keeping with this new curriculum schedule, it was necessary to combine MS2 and MS3 students on clerkships from January to June; during that time, both MS2 and MS3 students are on the same clerkship simultaneously, creating opportunities for informal near-peer learning. Each clerkship handles this mixing differently: some create mixed-year teams, others group students together with their peers, while still others do not create teams at all. OBJECTIVE: We are interested in determining the impact of mixing students on team dynamics, narrative assessments, and grades. HYPOTHESIS: Upperclassmen and underclassmen participating on the same clerkships in a mixed learning environment will report predominantly positive experiences but will have significant differences in their grades and narrative assessments compared to each other. METHODS: A tri-pronged approach was taken, looking at qualitative student perspectives, qualitative attending perspectives, and quantitative scores on de-identified student evaluations. In the first arm of the study, students in the classes of 2020 and 2021 were sent a voluntary survey seeking comments regarding their experiences on mixed clerkships and to indicate their interest in participating in a follow-up 30-minute focus group interview. Four purposeful focus groups of 4-5 students, two groups from each class, were interviewed to learn more about perceived advantages and disadvantages of mixed clerkships. Interviews were audio-recorded, transcribed, and coded for themes. Transcripts were validated by the interviewees and de-identified prior to analysis. In the second and third arms of the study, student evaluations from 2019 in the Internal Medicine, Pediatrics, and Psychiatry clerkships were gathered and de-identified. From these, 120 narrative assessments were randomly selected for qualitative analysis. Final grades and four scored skills were selected for quantitative analysis. Finally, de-identified quantitative data from 2015-2016, prior to the implementation of the 18-month curriculum, were analyzed for additional insights. RESULTS: In the first arm of the study, interviewees reported overall positive experiences with mixed clerkships. Common perceived advantages as an MS2 paired with MS3s included being able to ask "dumb" questions without being judged; being taught "practical" skills such as how to use the electronic medical record (EMR) and how to write a note; having fears allayed through candid discussions; and having a sense of camaraderie. Common advantages as an MS3 paired with MS2s included satisfaction in teaching MS2s and being motivated by MS2 enthusiasm. Perceived disadvantages were less commonly mentioned but still present, and mostly centered around fears of being compared by evaluators. In the second and third arms of the study, the mixed clerkships of Pediatrics and Psychiatry tended to show more significant differences in MS2 and MS3 evaluations than the non-mixed clerkship of Internal Medicine. However, this was highly nuanced, and there was some, but not consistent, division between differences observed in "learned" skills such as history-taking or note-writing and "inherent" skills such as professionalism or confidence. Comparison with students on the old curriculum also revealed significant differences with different MS2 and MS3 cohorts suggesting both positive and negative effects of the mixed learning environment on student evaluations. CONCLUSION: Overall, students reported more positive experiences and perceived advantages on mixed clerkships than negative experiences and disadvantages. However, attendings reported a higher proportion of significant differences between less and more experienced students on mixed clerkships. Despite this, the impact of cross-class comparison versus other factors, such as natural student improvement, contributing to these differences is unclear, and therefore mixed clerkships resulting from the 18-month curriculum have had a generally positive impact despite some negative effects. Further research, including research into other assessments of educational outcomes such as shelf exam scores as well as research into cross-clerkship comparisons, is needed to provide a fuller picture of the impact of these mixed clerkships.Item Assessing Self-Care Perception in Patients Living with Type 2 Diabetes and Their Physicians(2021-05-01T05:00:00.000Z) Balakrishnan, Naveen Kishore; Day, Philip; Kale, Neelima; Schneider, DavidBACKGROUND: Type 2 diabetes mellitus (T2D) is chronic illness affecting millions in the United States. Patients living with T2D require highly individualized care and significant patient effort. This effort is comprised of the patient's self-care with regards to medication, diet, lifestyle, and mental health. Self-efficacy is a patient's ability to feel agency over their illness and therefore feel able to maintain self-care. Previous literature suggests that improving a patient's self-efficacy through various behavioral health interventions may improve a patient's ability to manage their T2D. Additionally, interventions on self-efficacy are thought to work regardless of health literacy level and might be a generalizable intervention. However, while validated surveys assessing patient diabetes distress, quality-of-life, social determinants of health, adverse childhood events, and more exist, no literature was found attempting to understand a patient's perspective on their self-care, and by extension, their self-efficacy. Under the premise that consistent beliefs between patient and physician regarding self-care are necessary to make meaningful plans promoting self-care and self-efficacy, the authors developed the term self-care perception consistency to assess relationship between patient and physician perceptions of a patient's self-care. OBJECTIVE: The objective is to assess the consistency between patient and physician perceptions of patient self-care through a biopsychosocial and structural/social determinants of health lens. METHODS: This study uses a cross-sectional, quantitative data set obtained by the Research Residency Network of Texas (RRNeT) through a 71-item survey study. This survey was completed across 12 Family Medicine residencies in Texas and included individuals between 18-75 who were living with T2D. Responses ranged from short free response to Likert-scale based questions and covered topics such as demographics, social determinants of health, patient self-care, diabetes distress, quality-of-life, adverse childhood events, and more. The physicians of each patient were asked to complete a shorter 10-item survey with broader analogous questions to the patient survey. This data was collected through RedCap and analyzed through RStudio. RESULTS: The term self-care perception consistency was coined to describe the relationship between the patient's and physician's perception of the patient's self-care. Self-care perception consistency was found to be lacking 31.2% of the time. Only HgA1c (p<0.01) was inversely correlated with self-care perception consistency in both the univariate and multivariate analyses of demographic factors and social determinants of health. Additional analysis was completed to assess the relationship of HgA1c control, patient diabetes distress, patient quality-of-life, and the physician survey with self-care perception consistency. Self-care perception consistent and inconsistent groups were found to have significantly different HgA1c control distributions (p < 0.01) in the subset of patients that rated their self-care positively, but no significant difference was found in the group that rated their self-care negatively. Patient self-care ratings were best correlated with their diabetes distress (p<0.01) and HgA1c (p<0.01) while physician ratings of patient self-care were best correlated with their perception of HgA1c, perception of patient diabetes distress, perception of patient quality-of-life, and perception of patient social connectedness (p<0.01 for all). Notably, trending diabetes distress, quality-of-life, the physician survey, and social determinants of health across patient self-care ratings in self-care perception consistent versus inconsistent groups revealed that only the physician survey showed opposite trends across the consistent and inconsistent groups. CONCLUSION: Self-care perception consistency was found to be lacking 31.2% of the time. Notably, HgA1c is correlated with patient and physician perceptions of patient self-care (p<0.01 for both); however, in instances of patient-physician self-care perception inconsistency, HgA1c is not correlated with patient self-care perception. Instead, diabetes distress remains predictive of patient self-care rating in all instances (p<0.01). Patient-physician self-care perception inconsistency is also associated with inconsistency in patient and physician perceptions of the patient's diabetes distress. As diabetes distress remains consistently correlated with patient self-care rating, using the validated diabetes distress survey-17 with an additional question regarding self-care may help physicians better understand patients and therefore target appropriate education and psychosocial interventions.Item Consult a sickle cell expert: how to apply NIH guidelines in caring for adult sickle cell patients(2017-01-20) Nero, AleciaItem Contraceptive Use Across Cultures: A Cross-Cultural Comparison of Contraceptive Use in Women Seeking Care at Sun Yat-sen University Hospital, China and Monduli District Hospital, Tanzania(2016-04-01) Cheng, Cece; Roberts, Scott; Wells, C. Edward; Niwagaba, LillianOBJECTIVE: The purpose of this study was to determine and compare contraceptive choices in women in China and Tanzania and to assess the factors associated with their contraceptive choice. STUDY DESIGN: A prospective cohort trial was performed at Sun Yat-sen University in Guangzhou, China (06/2013 - 08/2013) and the Monduli District Hospital in Monduli, Tanzania (08/2015 - 09/2015). Women were approached during either an inpatient or outpatient visit with an Obstetrics/Gynecology practitioner and asked to complete a survey in their native language (Mandarin or Kiswahili) after obtaining verbal consent. The survey included demographic and social data, socioeconomic status (SES), obstetric history, and contraceptive choice. Data were analyzed using Student’s T-test and Chi-square test for continuous and categorical data, respectively. A P<0.05 was considered statistically significant. RESULTS: During the study period, a total of 128 Chinese women and 61 Tanzanian women completed the survey. Most women chose to use condoms with very few women using long acting reversible contraceptives. However, in the Tanzania population, other popular methods of contraception included LARCs such as implants as well as injections. In addition, elective abortion rates were significantly higher in Chinese women than Tanzanian women (P <0.05). Chinese women <21 and >35 years of age used some form of contraception compared with women in the 21-35 year old range who were more likely to not use contraception, while very few Tanzanian women in the <21 had ever used contraceptives. In addition, those in higher socioeconomic classes/with higher education were less likely to use contraceptives in the Chinese population, but more likely to use contraceptives in the Tanzanian population. CONCLUSION: Contraceptive use in China and Tanzania was clearly influenced by many factors. The high rate of condom use compared to longer, more sustainable methods of contraception highlight a need for better contraception education in both developing countries.Item The ethics of defibrillators and end of life care: the patient, not the device(2014-07-25) Sulistio, MelanieItem From prehab to rehab: opportunities in geriatric perioperative medicine(2017-06-16) Dalton, Thomas O.Item Health maintenance and IBD: collaborative approach between PCP and specialist(2014-08-22) Ahmed, TasneemItem Healthcare Provider and Community Adult Knowledge and Beliefs about Adolescent Sexual and Reproductive Health(2018-07-20) McDonald, Wade Compton; Stewart, Sunita M.; Faith, Melissa A.; Bordes Edgar, Veronica; LePage, James; Hughes, Jennifer L.Sexual and gender minority (SGM) youth face discrimination and health/healthcare disparities in American society (Mustanski, Birkett, Greene, Hatzenbuehler, & Newcomb, 2014a). Researchers have demonstrated connections between discriminatory beliefs (e.g., homophobia), beliefs about environmental etiology of SGM, and SGM moral condemnation among United States adults (Wood & Bartkowski, 2004). Previous research has not established whether pediatric healthcare providers share attitudes and beliefs with other U.S. adults. To address SGM youth’s healthcare disparities, one important step is to understand pediatric healthcare providers’ SGM-specific attitudes and beliefs, what factors influence providers’ beliefs, and how providers’ beliefs differ from the greater community. Our study surveyed a national sample of community adults (n=258) and a sample of pediatric healthcare providers (n=103). The primary aim was to validate three novel measures in both samples: a measure assessing knowledge about sexual minority health risks, a measure assessing SGM etiology beliefs, and a measure assessing moral condemnation of SGM identities. We expected etiology beliefs and moral condemnation to contain separate sexual minority (SM) and gender minority (GM) factors when subjected to exploratory and confirmatory factor analyses. This study’s secondary and tertiary aims examined associations between SM knowledge, SGM etiology beliefs, moral condemnation, and homophobia in our community adult and pediatric healthcare provider samples. We anticipated healthcare providers would demonstrate more SM health risk knowledge, more biological etiology beliefs, and less moral condemnation. Our measures demonstrated good psychometric properties. Contrary to expectations, the etiology and moral condemnation measures were unidimensional for all SGM behaviors and identities. Providers demonstrated more SM health risk knowledge than community adults, but this knowledge was not statistically explained by the quantity of participants’ self-reported SGM-specific prior training. Providers and community adults demonstrated similar etiology beliefs, which were associated with moral condemnation and self-reported religiosity. Moral condemnation was lower in the provider sample, and was associated with spirituality, religiosity, previous interaction with SM individuals, and the presence of a SGM friend or family member. This study lays groundwork for future research designed to better understand pediatric healthcare providers’ SGM-specific knowledge and beliefs and to, ultimately, improve healthcare provision for at-risk SGM youth.Item Improving Compliance via Education, Reminders, and Evaluating Physician-Patient Concerns in Glaucoma(2022-05) Wang, Chuhan Carey; Kooner, Karanjit; Reed, W. Gary; Phelps, EleanorPURPOSE: To improve glaucoma treatment compliance via education, medication reminders, and understanding of patient and physician concerns. DESIGN: Prospective Comparative Case Series SUBJECTS: 194 consecutive eligible patients diagnosed with primary open angle glaucoma or ocular hypertension at a single academic center (92 male and 102 female) and 16 glaucoma specialists volunteered their responses. METHODS: All 194 eligible patients were interviewed regarding glaucoma knowledge, medication usage, concerns, and fears. They were counseled, given educational handouts, and reinterviewed after 4 weeks. All 16 glaucoma specialists were also surveyed regarding their concerns for their patients. MAIN OUTCOME MEASURE: Patient's knowledge of the basic premise of glaucoma, compliance to their medications, including concerns and fears of glaucoma in both patients and physicians. RESULTS: In this study, patients aged ≥ 65 years were more compliant than those < 65 years (76% vs 50%, p<0.05). In follow-up interviews of 125 (64%) patients, I found significant increase in glaucoma knowledge from 53% to 67% (p<0.05) and compliance from 77% to 94% (p<0.05). In addition, patients' major fear was becoming dependent on others (p<0.05), while physicians were more concerned about patients' ability to administer eyedrops and understanding of instructions (p<0.05). CONCLUSION: I found that patients aged ≥ 65 were more compliant. Our intervention improved patient compliance by 17 % and represents a potential model for glaucoma management. In addition, the disparity between patient and physician fears suggest that communication barriers must be addressed to improve patient care.Item Improving Nutritional Knowledge of Caregivers in Hyderabad, India: A Pilot Study(2019-04-02) Tinger, Sophia Tibe; Patterson, Abigail M.; Reed, W. Gary; Phelps, EleanorBACKGROUND: India has the highest prevalence of underweight children under 5 in the world. While lack of access to food is one contributing factor to undernutrition, a caregiver's nutritional knowledge is a more important determinant. Caregivers can improve their nutritional knowledge through nutritional counselling, which is already one of the standard management options for treating children with mild to moderate malnutrition. Therefore, improving nutritional counselling for caregivers can be an effective way to combat undernutrition. OBJECTIVE: The aim of this study was to increase caregiver nutritional knowledge gained after receiving diet counseling at Niloufer Hospital, in Hyderabad, India, by 25% by March 2017 through the use of quality improvement tools. METHODS: Checklists and flipcharts were designed using PDSA cycles and DMAIC, two frequently used quality improvement tools. These interventions were then sequentially implemented in two-week increments over a period of six weeks. Caregivers of children 5 and under were given short surveys both before and after counselling. Change in knowledge scores were calculated from the difference in the pre- and post-counselling survey scores. This was done for three different age groups over each phase of the project: Baseline Phase, Checklist Phase, and Flipchart Phase. This data was then analyzed using a one-way ANOVA, as well as a post-hoc analysis with a student-Newman-Keuls test to confirm the ANOVA. RESULTS: The aim was achieved for all age groups when comparing the change in knowledge scores from the final phase (Flipchart Phase) to the Baseline Phase. For the Under 6 Months age group, the change in knowledge scores were 5.24, 10.17, and 12.20 for the Baseline, Checklist, and Flipchart phases respectively. The percent increase from the Baseline Phase to the Flipchart phase was 132.8%. For the 6 to 35 Months group, the change in knowledge score was 9.25 in the Baseline Phase, 8.14 in the Checklist Phase, and 18.86 in the Flipchart Phase, a 103.9 percent increase from the Baseline Phase. Finally, there was a change of knowledge score of 3.57 in the Baseline Phase, 6.25 in the Checklist Phase, and 29.17 in the Flipchart Phase for the 3-5 Years age group. This age group showed a 717.1 percent increase between the Baseline Phase and the final phase of the study. There were no statistically significant findings in this pilot study. However, there was a positive trend showing the flipcharts were the most effective intervention. CONCLUSION: This pilot study demonstrated that these simple-to-create and low-cost interventions, especially the flipcharts, can improve knowledge gained through counselling in low resource settings. Future studies are needed to determine if these interventions can be improved and expanded for wider use.Item Knowledge and Perception of Cervical Cancer and Screening Programs of Women Seeking Care at Monduli Hospital in Tanzania and St. Paul Hospital in Addis Ababa, Ethiopia(2015-04-03) Ghidei, Luwam; Lea, JayanthiAlthough a 2010 survey assessing Tanzanian women's knowledge and attitude towards cervical cancer demonstrated over 75% of respondents correctly identified early marriage and multiparty, other studies demonstrated a lack of knowledge about cervical cancer screening and HPV transmission among patients and nurses. Additionally, many women in Tanzania are not readily represented in such questionnaires. Women who are able to attend clinics with screening programs are generally from higher socioeconomic backgrounds, younger, and more knowledgeable about cervical cancer.15 Educational programs focused on the importance of cervical screening in rural remote areas of Tanzania may have a positive impact on the early detection and identification of patients at early disease stage. Considering both Tanzania and Ethiopia had established VIA programs in 2011 (Figure 5), I developed a questionnaire to assess the knowledge and perception of cervical cancer and cervical cancer screening programs of women in Tanzania and Ethiopia to guide future cervical cancer prevention and screening educational programs in communities.Item Medicine in this day and age: addressing ageism in healthcare(2023-12-15) Voit, Jessica H.Item National Practices, Attitudes, and Training Surrounding Long-Acting Reversible Contraception Procedures for Adolescents(2024-05) Edmondson, Shelby Nicole; Francis, Jenny K. R.; Sendelbach, Dorothy; DeSilva, Nirupama K.BACKGROUND: Primary care for adolescents in the United States is predominantly provided by pediatricians. For these patients, sexual health and contraception are important parts of primary care. Despite this, pediatricians are often less comfortable providing contraceptive counseling and lack training to administer long-acting reversible contraception (LARC), a highly effective form of contraception. Medically- and socially- complex patients access to contraception is additionally limited, as they often receive much of their medical care in the hospital setting. Training pediatricians and pediatric hospitalists to effectively administer LARC in both outpatient and inpatient settings would increase adolescent access to sexual health care, including LARC. OBJECTIVE: This mixed-methods study aims (1) to quantitatively describe national practices and training for providing sexual health services, including LARC, in the inpatient setting and (2) to qualitatively characterize the attitudes of clinicians about the appropriateness of and training surrounding LARC procedures for adolescents in the inpatient setting to generate strategies to improve training for pediatricians. METHODS: For aim 1, pediatric providers across the nation were invited to complete an online REDCap survey to assess current LARC services at their institution, attitudes about desiring LARC services, and interest in LARC training. Descriptive frequencies were reported. For aim 2, focus group interviews of a subsample of survey participants were facilitated on Zoom to assess barriers and facilitators to sexual health services and training for these sexual health services in pediatric hospitals. Interviews were transcribed and coded using Nvivo. Discordance was resolved by consensus and thematic analysis was performed. RESULTS: Survey data (n = 610) indicated that inpatient LARC services are currently limited (12% and 19% of participants reporting IUDs and implants, respectively, administered inpatient at their hospital site). Among those at hospitals not currently placing LARC, many wished this service was available (43% for IUD and 37% for implant) and over half were willing to learn how to place LARC (49% for IUD and 56% for implant). From the interview data (n = 32), beliefs in the appropriateness of administering LARC to adolescents varied, but many believed it was appropriate in all settings, including inpatient as "every hospitalization is an opportunity to review healthcare maintenance, and contraception- that's healthcare maintenance for a teenager." Regarding training, lack of willingness to learn how to place LARC centered around lack of knowledge, skills, and resources for pediatricians and pediatric hospitalists. Although training opportunities are often available, they are usually elective and at inopportune times. Those who have successfully received training reported it occurring during scheduled training blocks and including instructions on confidentiality and billing. CONCLUSION: Some of the limited availability of LARC for adolescent patients can be attributed to limited contraceptive training for pediatricians and pediatric hospitalists. To expand access, training opportunities for pediatric trainees should be scheduled as part of mandatory didactics and include didactic, simulation, and clinical practice components that touch on logistic aspects including acquiring equipment, confidential counseling, and billing and documentation.Item [News](1978-03-27) Williams, AnnItem [News](1979-09-12) Spiegel, RichardItem Training through a Novel Community-Engaged Research Project to Reduce Pregnancy-Associated Morbidity and Mortality from Maternal Sepsis in New York City(2024-01-30) Zhao, Alice; Richardson, Briana; LaHote, Jessica; Oktem, Ayda; Plumlee, Austin; Hall, Kelli StidhamMaternal sepsis is the second-leading cause of maternal mortality in the U.S., with a disproportionate impact among racial and ethnic minorities. Although maternal sepsis is largely preventable, there remains little evidence concerning the management of risk factors to ensure safe and equitable maternal care during delivery and transition to postpartum. The EnCoRe MoMS study (Engaging Communities to Reduce Morbidity from Maternal Sepsis) is a comprehensive, community-engaged project focused on reducing pregnancy-associated sepsis risk and promoting maternal health equity in NYC. Community stakeholders are integrated in the community research design process through the Community Organization Leadership Advisory Board (CoLAB). I aimed to contribute to the qualitative portion of the ongoing EnCoRe MoMS study to better understand how the social determinants of health impact the lived experiences of patients and how qualitative interviewing can uncover specific barriers and proposed solutions that may be implemented across the pregnancy continuum. We developed an efficient workflow for the recruitment, consent, and enrollment of patients, then conducted qualitative in-depth interviews (IDIs) with postpartum patients and community focus group discussions (FGDs). Major themes explored during IDIs included prenatal and labor/delivery experiences, facilitators/barriers to accessing quality maternal care, respectful care, community-based resources and solutions, etc. (see table). Ultimately, qualitative data collection through IDIs and the FGD allowed us to observe the lived experiences of patients at high risk of pregnancy and postpartum complications, including sepsis.Item An update: management and treatment of hepatitis C virus infection(2014-09-05) Brown, GeriItem Using Ethnography to Capture Learner Experience in Handover Simulation Modules(2022-05) Jacob, Benjamin Richard; Reed, W. Gary; Greilich, Philip; Phelps, EleanorBACKGROUND: Patient handovers, frequent, diverse, and integral parts of modern medical practice, involve the transfer of patient responsibility from one team of providers to another.1 This transition of care is often fragmented and has been shown to cause various adverse events, including patient injury, medication errors, and lengthened hospital stays.2-4 LOCAL PROBLEM: As simulation-based activities have increased in medical schools across the nation, an accompanying need to understand the learner experience has developed.5,6 UTSW has incorporated simulation-based learning with the Quality Enhancement Plan (QEP) to teach medical and health professions students team based communication. The aim of this study was to characterize learner attitudes toward simulation education during two simulation-based modules and to determine critical-to-quality elements of these courses through focused ethnography. METHODS: We describe a focused ethnographic study of two simulation-based modules of handover education using direct participant observation. The observers, medical students, and physician assistant student participant of these modules were asked to provide reflective summaries of their experiences during the simulation, including a description of what happened, attitudes about the experience, and reflections on potential improvement. Using qualitative analysis software, these ethnographic summaries were coded, and major themes were identified These themes were subsequently used to develop critical elements of the simulation activity in a Critical to Quality (CTQ) tree. RESULTS: Our analysis showed that the handover-simulation modules were regarded as generally both acceptable and appropriate. Coding of the ethnographic summaries clarified the major proponents of and deterrents to acceptability (Figure 2). Our analysis determined five components for a quality experience: organization, safety/security, engagement, reinforcement, and standardization. Out of the five critical to quality elements we identified, all five needs were described and confirmed in two concomitant focus group analyses of handover-simulation module participants, further validating an ethnographic approach in this context. CONCLUSION: Ethnographic research methods are an efficient and effective way to characterize learner attitudes and experiences in simulation education. Focused ethnography has identified several significant targets for improving the Safe Patient Handover simulation.Item Vaccine hesitancy(2021-05-21) DuVal, Tara