Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities
Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care.
Improvement science (IS) is the foundation of knowledge for systematic and rigorous efforts to redesign systems and processes to improve quality and eliminate error by emphasizing continuous measurement and dissemination to promote positive change. This institution-wide faculty development program described at Oregon Health & Science University to build such skills and new curricula was used for didactics, interactive sessions, coaching, and self-assessed competency mapping. This improvement in IS curricula increased the perception of IS skills among faculty and staff participants. (Ray M, Gelmon S, DiVeronica M, Lepin K). J Grad Med Ed 2019; 12 : 678-684.
Many faculty struggle with providing high-quality feedback to learners. This prospective study examined the value of a simple, one-time feedback session for faculty in an internal medicine department. Feedback from students, residents, and fellows was gathered before and after the faculty member attended this session. Findings demonstrated that this framework led to improved feedback and more specific next steps, reasons why, and anticipated outcomes. Combining learning of the described simple feedback framework with an immediate review of written comments led to measured improvement in written comments from faculty to their learners. (Zelenski AB, TIshchendorf JS, Kessler M, et al. J Grad Med Educ 2019; 11: 468-471. Doi: 10.4300/JGME-D-10-00058.1). PMID: 31440343
High proportions of preventable morbidity and mortality are attributable to social determinants of health (SDOH). This investigation used a single questionnaire to assess residents’ perceived competence at identifying, discussing, and addressing SDOH in outpatient settings. Although most residents had prior SDOH training, only a small proportion reported being highly competent at identifying or addressing SDOH. Factors associated with higher competence of certain residents were their older age, lower childhood household income, prior education about SDOH, primary practice site, and intention to practice primary care. Practical training should include implementation to more effectively address SDOH in outpatient practice. (Gard LA, Cooper AJ, Youmans Q, et al. BMC Med Educ 2020; 16: 18. Doi: 10.1186/s12909-020-1931-1). PMID: 31948434
Graduate Medical Education
The “continuum of learning” ideal is yet to be realized, although lifelong learning must be promoted as an achievable goal. This forum from the East Carolina University emphasizes the shift to competency-based training by combining efforts of graduate medical education and continuing medical education. Complementary threads of accreditation requirements, expertise, resources and scholarly activities are explained as to how the two can operate in a more integrated and coordinated fashion. Examples of complementary ACGME and ACCME accreditation requirements are demonstrated in this partnership model. (Whitehurst KE, Carraway M, Riddick A, Basnight L, Garrison HG. JCEHP 2019: 39: 270-275. Doi: 10.1097/CEH.0000000000000271).
Quality Improvement, Patient Safety and Other Topics
Through academic detailing (an evidence-based educational approach), these investigators aimed to implement and measure the effect of an educational programme based around peer-reviewed audits with or without a small group lecture and case review. The programme took place across a large clinical commissioning group consisting of 55 primary care practices Qualitative feedback was obtained at peer review sessions, and questionnaires were completed at baseline and post-intervention. Significant improvements were found in the percentage of correct answers before and after the intervention. While academic detailing was rated highly as being useful, half of the participants expressed some anxiety about case discussions with peers.
(Noble RA, McKinnell JC, Shaw S, Bassett S, et al. BMC Med Educ 2019; 19: 253- 259. Doi: 10.1186/s12909-019-1659-y). PMID: 31288803
Health care is data-driven, and greater accessibility to data has created more opportunities to use data to improve quality of care and patient outcomes. Understanding factors that influence physician engagement with practice data is important to advance competence and drive practice change. This practice-based, pan-Canadian survey was administered to 305 psychiatrists, radiation oncologists, and general surgeons through national specialty society memberships. The authors found that strategies to help support learner interpretation of data, such as coaching and feedback, may be beneficial. Research in this area may yield further insights into the transition from providing data to learners to eventual data-informed learning. (Sockalingam S, Tavares W, Charow R, et al. JCEHP 2019; 39: 236-242. Doi: 10.1097/CEH.0000000000000268).
Continuing education of physicians is often obtained from reading manuscripts published in medical journals. Predatory journals are low-quality scientific journals with an exploitative business model that extracts fees from authors. They fail to provide scientific rigor or transparency, in part because they do not provide quality control, editorial services or peer review. Given that authors and readers often judge the quality of journals on their editorial boards, this quantitative study describes the profiles of members of editorial boards of many such journals. The results dispute the common belief that it is possible to identify predatory journals by checking their editorial boards alone. (Ruiter-Lopez L, Lopez-Leon S, Forero D. Med Teach 2019; 6: 691-696. Doi: 10.1080/0142159X.2018.1556390). PMID: 30794759