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BACKGROUND The University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train
physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction
at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously
shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment
to medically disadvantaged populations over the course of medical education.
OBJECTIVE To examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice
location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged
areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty
choice.
DESIGN Retrospective cohort study.
PARTICIPANTS Graduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985–1995, practicing in
California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile.
MEASUREMENTS Physician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was
defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority
area; or (d) high poverty area.
RESULTS Fifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates.
In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10–2.25) and participation in the
Drew program (OR: 2.47; 95% CI: 1.59–3.83) were independent predictors of future practice in disadvantaged areas.
CONCLUSIONS Physicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas
than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity.
The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests
that medical education programs may reinforce student goals to practice in disadvantaged communities. 相似文献
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Purpose 1) To pilot a health disparities curriculum for incoming first year medical students and evaluate changes in knowledge. 2)
To help students become aware of personal biases regarding racial and ethnic minorities. 3) To inspire students to commit
to serving indigent populations.
Methods First year students participated in a 5-day elective course held before orientation week. The course used the curricular goals
that had been developed by the Society of General Internal Medicine Health Disparities Task Force. Thirty-two faculty members
from multiple institutions and different disciplinary backgrounds taught the course. Teaching modalities included didactic
lectures, small group discussions, off-site expeditions to local free clinics, community hospitals and clinics, and student-led
poster session workshops. The course was evaluated by pre-post surveys.
Results Sixty-four students (60% of matriculating class) participated. Survey response rates were 97–100%. Students’ factual knowledge
(76 to 89%, p < .0009) about health disparities and abilities to address disparities issues improved after the course. This curriculum
received the highest rating of any course at the medical school (overall mean 4.9, 1 = poor, 5 = excellent).
Conclusions This innovative course provided students an opportunity for learning and exploration of a comprehensive curriculum on health
disparities at a critical formative time. 相似文献
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Barbara L. Schuster 《The American journal of the medical sciences》2017,353(2):119-125
The graduate medical education (GME) process in the United States is considered the most respected model for high-quality education of graduate physicians in the world. With substantial funding through government and private insurers and through structured educational accreditation standards, the American Board of Medical Specialists–certified physicians are recognized for their expertise in delivering high-quality medical care. However, under fiscal constraints and changing social expectations, questions are continually posed about the process of funding and whether the “physician outcomes” are sufficient to continue with the investment. This article reviews the history of postgraduate physician education, the multiple funding pathways, disruptions to a placid educational system and changing social expectations. The ultimate issues involve the core goals of GME and how much GME should shoulder responsibility for changing the healthcare system. 相似文献
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Remote patient monitoring sustains reductions of hemoglobin A1c in underserved patients to 12 months
Elizabeth B. Kirkland Justin Marsden Jingwen Zhang Samuel O. Schumann John Bian Patrick Mauldin William P. Moran 《Primary Care Diabetes》2021,15(3):459-463
AimsWe sought to determine whether underserved patients enrolled in a statewide remote patient monitoring (RPM) program for diabetes achieve sustained improvements in hemoglobin A1c at 6 and 12 months and whether those improvements are affected by demographic and clinical variables.MethodsDemographic and clinical variables were obtained at baseline, 6 months and 12 months. Baseline HbA1c values were compared with those obtained at 6 and 12 months via paired t-tests. A multivariable regression model was developed to identify patient-level variables associated with HbA1c change at 12 months.ResultsHbA1c values were obtained for 302 participants at 6 months and 125 participants at 12 months. Compared to baseline, HbA1c values were 1.8% (19 mmol/mol) lower at 6 months (p < 0.01) and 1.3% (14 mmol/mol) lower at 12 months (p < 0.01). Reductions at 12 months were consistent across clinical settings. A regression model for change in HbA1c showed no statistically significant difference for patient age, sex, race, household income, insurance, or clinic type.ConclusionsPatients enrolled in RPM had improved diabetes control at 6 and 12 months. Neither clinic type nor sociodemographic variables significantly altered the likelihood that patients would benefit from this type of technology. These results suggest the promise of RPM for delivering care to underserved populations. 相似文献
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Stephen Devries Arthur Agatston Monica Aggarwal Karen E. Aspry Caldwell B. Esselstyn Penny Kris-Etherton Michael Miller James H. OKeefe Emilio Ros Anne K. Rzeszut Beth A. White Kim A. Williams Andrew M. Freeman 《The American journal of medicine》2017,130(11):1298-1305
Background
Nutrition is one of the foundations of cardiovascular guidelines for risk reduction and treatment. However, little is known about whether cardiologists, cardiology fellows-in-training, and cardiovascular team members have the nutrition education and knowledge necessary to implement these guidelines. The aim of this study was to describe the educational experiences, attitudes, and practices relating to nutrition among cardiovascular professionals.Methods
Surveys completed by cardiologists, fellows-in-training, and cardiovascular team members inquired about their personal dietary habits, history of nutrition education, and attitudes regarding nutrition interventions.Results
A total of 930 surveys were completed. Among cardiologists, 90% reported receiving no or minimal nutrition education during fellowship training, 59% reported no nutrition education during internal medicine training, and 31% reported receiving no nutrition education in medical school. Among cardiologists, 8% described themselves as having “expert” nutrition knowledge. Nevertheless, fully 95% of cardiologists believe that their role includes personally providing patients with at least basic nutrition information. The percentage of respondents who ate ≥5 servings of vegetables and fruits per day was: 20% (cardiologists), 21% (fellows-in-training), and 26% (cardiovascular team members).Conclusions
A large proportion of cardiovascular specialists have received minimal medical education and training in nutrition, and current trainees continue to experience significant education and training gaps. 相似文献9.
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Douglass Bibuld 《Clinical reviews in bone and mineral metabolism》2009,7(1):63-76
Research over the last two to three decades has slowly demonstrated that Vitamin D, a long neglected and unappreciated hormone,
is of profound importance to human health and survival. Vitamin D begins its synthesis in human skin with ultraviolet B radiation
(UVB) from the sun. Melanin is a potent UVB blocker, protecting the skin from the high intensity sunlight found on the tropical
savannah into which humans evolved, but not impairing the skin’s ability to synthesize generous quantities of vitamin D there.
Adaptation to environmental availability of UVB radiation from the sun appears to explain the variation in skin melanin content
in indigenous human populations around the world. Evidence shows populations in the United States have mean vitamin D levels
that are associated with the relative amount of melanin in the skin in those populations, and that humans with insufficient
levels of vitamin D suffer disproportionately from the diseases associated with health disparities. The differences in incidence
and severity of cardiovascular diseases, the most common cancers, diabetes, tuberculosis, conditions associated with infant
mortality, and total mortality in populations associated with health disparities in the United States are explored in this
chapter. Indeed, the magnitude of the disparity in diseases associated with “health disparities,” related to the effect of
vitamin D on those diseases, is such that eliminating the differences in vitamin D levels between the populations would appear
to virtually eliminate the health disparities between them. 相似文献
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Leveraging Computerized Sign-Out to Increase Error Reporting and Addressing Patient Safety in Graduate Medical Education 下载免费PDF全文
SUMMARY
Setting Electronic reporting systems are important components of the patient-safety movement but have been problematic particularly
in capturing information from physicians.
Objective In an attempt to increase error reporting in our community hospital residency program, we devised a convenient safety log
integrated into the computerized resident-patient sign-out.
Measurements and Main Results Safety-log events are discussed in weekly safety reports with emphasis on developing a safety culture and preventing further
events. We report our experience implementing the safety log. The program quadrupled our contribution to the hospital quality
assurance system and has led to significant system innovations. Challenges have included sharing information and improving
accountability without humiliating participants or alienating co-workers, as well as sustaining the project over time.
Conclusion Residents are uniquely placed to provide insight into hospital systems. An error-reporting system based in a resident sign-out
can leverage this role into an important tool for safety education and care improvement. 相似文献
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Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education 下载免费PDF全文
Background Despite the popularity of medical student-run health clinics among U.S. medical schools, there is no information about how
many clinics exist, how many students volunteer there, or how many patients they see and what services they offer.
Objective We describe, for the first time, the prevalence and operation of medical student-run health clinics nationwide.
Design and participants A web-based survey was sent to all 124 Association of American Medical Colleges allopathic schools in the 50 states.
Results Ninety-four schools responded (76%); 49 schools had at least 1 student-run clinic (52%). Fifty-nine student-run clinics provided
detailed data on their operation. The average clinic had 16 student volunteers a week, and most incorporated preclinical students
(56/59, 93%). Nationally, clinics reported more than 36,000 annual patient–physician visits, in addition to more nonvisit
encounters. Patients were predominantly minority: 31% Hispanic; 31% Black/African American; 25% White; 11% Asian; and 3% Native
American or other. Most student-run health clinics had resources both to treat acute illness and also to manage chronic conditions.
Clinics were most often funded by private grants (42/59, 71%); among 27 clinics disclosing finances, a median annual operating
budget of $12,000 was reported.
Conclusions Medical student-run health clinics offer myriad services to disadvantaged patients and are also a notable phenomenon in medical
education. Wider considerations of community health and medical education should not neglect the local role of a student-run
health clinic. 相似文献
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Richard M. Wardrop Lee R. Berkowitz 《The American journal of the medical sciences》2017,353(2):116-118
The promotion of change and growth within medical education is oftentimes the result of a complex mix of societal, cultural and economic forces. Graduate medical education in internal medicine is not immune to these forces. Several entities and organizations can be identified as having a major influence on internal medicine training and graduate medical education as a whole. We have reviewed how this is effectively accomplished through these entities and organizations. The result is a constantly changing and dynamic landscape for internal medicine training. 相似文献
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