Academic medicine : journal of the Association of American Medical Colleges
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The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students' intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation. ⋯ This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students' decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.
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By describing an instance of racial violence by a patient against a resident physician, the authors hope to stimulate further discussion by addressing three specific questions about managing racist patients: (1) How should the resident (or any level of trainee) respond to the immediate situation? (2) How should the unit respond to the event as a community? and (3) How should the institution (hospital and/or academic institution) respond to the event? The authors argue that responses to such incidents should acknowledge the history of structural racism in U. S. society and in medicine. The authors recommend an approach that names the racism directly while addressing the safety of the patient and the providers in the moment, supports those affected in the aftermath, and considers appropriate consequences for the perpetrators of violence.
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The Penn State College of Medicine (PSCOM) faced escalating reports of learner mistreatment in 2013-2017. As systems were implemented to gather and respond to student reports, faculty members expressed concern that these were creating a culture that focused on negative behaviors to the exclusion of acknowledging outstanding teaching that was also occurring. ⋯ Future plans include examining the impact of being named an exceptional teacher, ways exceptional teachers create respectful teaching interactions, and common threads within student narratives that illuminate specific techniques, behaviors, and attitudes that create exceptional teaching experiences.
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Comparative Study
Debriefing for the Transfer of Learning: The Importance of Context.
The advent of simulation-based education has caused a renewed interest in feedback and debriefing. However, little attention has been given to the issue of transfer of learning from the simulation environment to real-life and novel situations. In this article, the authors discuss the importance of context in learning, based on the frameworks of analogical transfer and situated cognition, and the limitations that context imposes on transfer. ⋯ In decontextualization, the underlying abstract principles are extracted without reference to the situation, and in recontextualization, those principles are adapted and applied to new situations and to the real-life counterpart. This requires that the surface and deep features that characterize the lived situation be previously compared and contrasted with those of the same situation with hypothetical scenarios ("what if"), of new situations within the same family of situations, of the prototype situation, and of real-life situations. These strategies are integrated into a cyclical contextualization, decontextualization, and recontextualization model to enhance debriefing.
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The Triple Aim framework for advancing health care transformation elevated population health improvement as a central goal, together with improving patient experiences and reducing costs. Though population health improvement is often viewed in the context of clinical care delivery, broader-reaching approaches that bridge health care delivery, public health, and other sectors to foster area-wide health gains are gathering momentum. Academic medical centers (AMCs) across the United States are poised to play key roles in advancing population health and have begun to structure themselves accordingly. ⋯ Four key mission-bridging approaches offer a framework for population health departments in AMCs: engaging community, turning information into insight, transforming health care, and shaping policy. Challenges include tensions between research, practice, and evaluation; navigating funding sources; and sustaining an integrated, interdisciplinary approach. This framework of discipline-bridging, partnership-engaging inquiry, as it diffuses throughout academic medicine, holds great promise for realigning medicine and public health.