Faculty Bibliography

INTRODUCTION/UNASSIGNED:In response to accreditation bodies requiring health disparities curricula, medical educators are tasked with incorporating structural competency, the understanding of how social and structural barriers like structural racism impact health, into their teaching. Most have not received training in this area, yet there remains a scarcity of faculty development curricula to address this gap. We describe the creation, implementation, and evaluation of a faculty development workshop series rooted in the framework of structural competency. METHODS/UNASSIGNED:test. RESULTS/UNASSIGNED:< .001) incorporating structural competency. DISCUSSION/UNASSIGNED:Our application of structural competency to faculty workshops and teaching tools feasibly engages faculty in instruction to incorporate concepts of structural racism and the downstream effects of social determinants of health into clinical teaching. It represents an innovative tool as we seek to enhance clinical teaching to improve care for racially and ethnically minoritized communities.

INTRODUCTION/BACKGROUND:An important component of internal medicine resident education is morning (attending) rounds. Effective aspects of medical education include involving all team members, minimizing distractions, asking questions, and having ready access to data, all of which may not be present during rounds. There is limited information on learner-centered rounds or resident perspectives about education during rounds. To inform a learner-centered approach to rounds, the investigators conducted a focus group study of Internal Medicine residents exploring their perceived strengths and weaknesses of rounds, and how rounds could be better used as a teaching tool. METHODS:Three 60-min focus groups were conducted with N = 21 postgraduate year 2/3 Internal Medicine Residents at Montefiore Medical Center in Bronx, NY, USA in 2021-2022. Two resident investigators led the focus groups using a semistructured interview guide. Questions included defining types of rounds, benefits and pitfalls of various rounding styles, their impact on resident education, and recommendations to improve education on morning rounds. The sessions were audio recorded, transcribed verbatim, and de-identified. Transcripts were analyzed through inductive thematic analysis. RESULTS:Rounding styles identified were bedside, table rounds, and a hybrid approach. Three themes emerged through analysis of the data: (1) A hybrid model offers an optimal balance of education; (2) full bedside rounds have unintended pitfalls; and (3) Attending preparation affects the quality of rounds. CONCLUSIONS:Residents' perceptions of the education on attending rounds are impacted by both attending rounding style and advanced preparation. Our participants' insights could inform a rounding approach that optimizes both patient- and learner-centeredness.

Implicit biases are attitudes, emotions, or stereotypes that occur in an unconscious manner and have the potential to negatively affect behaviors, actions, and decisions. Recent studies have suggested that even when certain factors are controlled for, health care workers do not provide equitable care to patients from different demographics. When patients are not receiving equitable health care, there is a potential for disparities in patient-related outcomes. The purpose of this study was to determine attitudes toward implicit bias among athletic trainers. A secondary purpose of this study was to assess differences and correlations between attitudes toward implicit bias and demographic factors including age, years of experience, gender identity, sexual orientation, and race. Participants were recruited for this study by emailing athletic trainers from publicly available staff directories at institutions of higher education and high schools, and athletic training education program directors. The survey consisted of questions gathering demographic information and questions taken from the Attitudes Toward Implicit Bias Instrument. A total of 218 athletic trainers (age = 38 [11] y, years of certified experience = 14 [11] y) opened and completed the survey. On average, participants scored 71.0 [11.2] on the Attitudes Toward Implicit Bias Instrument. This mean score indicated that the average participant felt that implicit bias had the potential to negatively impact patient care and needed to be addressed through education. There was a significant, negligible negative correlation between age and attitudes toward implicit bias (r[216] = -.157, P = .02). Examining implicit bias among athletic trainers warrants further research to understand how implicit bias can negatively affect access to equitable health care opportunities. The development of high-quality interventions for identifying and addressing implicit bias is crucial to ensuring optimal patient outcomes in athletic training and all medical settings.

IMPORTANCE/UNASSIGNED:Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. OBJECTIVE/UNASSIGNED:To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. EXPOSURES/UNASSIGNED:In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Association between physicians' IAT scores and SP race with SP ratings of communication skills. RESULTS/UNASSIGNED:In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.

INTRODUCTION/UNASSIGNED:Despite the effectiveness of Diabetes Prevention Programmes (DPP) in reducing diabetes risk, primary care provider (PCP) referrals remain low, especially among men and racial/ethnic minorities, exacerbating their under-representation in DPPs. Understanding PCPs' perspectives on referrals is crucial for enhancing the intervention's reach and effectiveness. RESEARCH DESIGN AND METHODS/UNASSIGNED:We conducted a qualitative study to explore PCPs' experiences, perspectives and engagement with DPP referrals, focusing on factors influencing variations in referral rates. Based on electronic record data, high and low-referring PCPs from a large integrated health system in the Bronx, NY, participated in interviews conducted between February and September 2023. Interviews were conducted and recorded on Zoom, anonymised, transcribed and analysed using the constant comparative method. RESULTS/UNASSIGNED:From 22 PCP interviews, 4 themes emerged representing factors that influenced referrals: (1) perceived barriers to the patient engagement with the DPP, including infrastructure gaps, programme accessibility issues and unmet social needs, particularly affecting low-referring PCPs; (2) perceived effectiveness of the DPP, with concerns raised about its efficacy, especially for male and socioeconomically disadvantaged patients; (3) perceived self-efficacy in referring patients, driven by knowledge gaps and limited opportunities, especially among low-referrers and (4) recommendations to facilitate and strengthen referrals, highlighting areas for PCP and patient support. The perspectives of high-referring/low-referring PCPs often differed across these themes and associated subthemes. CONCLUSIONS/UNASSIGNED:Our research illuminates the challenges PCPs face in treating prediabetic patients and factors influencing DPP referrals in underserved populations. This understanding can guide interventions to enhance equitable DPP referrals and engagement, thereby reducing diabetes risk in vulnerable populations.

Recruiting and retaining research participants is challenging because it often requires overcoming structural barriers and addressing how histories of mistrust and individuals' lived experiences affect their research engagement. We describe a pilot workshop designed to educate clinical research professionals on using empathy skills to recognize and mitigate bias to improve recruitment and retention. In a post-workshop survey (22/31 participants completed), 94% agreed the workshop helped them practice perspective-taking, recognize implicit bias, and identify opportunities for empathy. Participants reported increased confidence in key recruitment and retention skills (p < 0.05). Future studies will evaluate whether this translates into improved recruitment.