Cayla R. Teal

Helping medical learners recognise and manage unconscious bias toward certain patient groups.

Medical Education 2012: 46: 80–88

When best intentions aren't enough: helping medical students develop strategies for managing bias about patients.

Introduction/AimsImplicit bias can impact physician–patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care.SettingSeventy-two third-year medical student volunteers participated in facilitated small group discussions about bias.Program DescriptionWe tested an educational intervention to promote group-based reflection among medical students about implicit bias.Program EvaluationWe assessed how the reflective discussion influenced students’ identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session

Improving quality of care through improved audit and feedback

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Conceptual challenges and practical approaches to screening capacity for self-care and protection in vulnerable older adults

, including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies.DiscussionGroup-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.

A guiding framework to maximise the power of the arts in medical education: a systematic review and metasynthesis.

BackgroundIn June 2004, the National Cancer Institute and the Drug Information Association co-sponsored the conference, “Improving the Measurement of Health Outcomes through the Applications of Item Response Theory (IRT) Modeling: Exploration of Item Banks and Computer-Adaptive Assessment.” A component of the conference was presentation of a psychometric and content analysis of a secondary dataset.ObjectivesA thorough psychometric and content analysis was conducted of two primary domains within a cancer health-related quality of life (HRQOL) dataset.Research designHRQOL scales were evaluated using factor analysis for categorical data, IRT modeling, and differential item functioning analyses. In addition, computerized adaptive administration of HRQOL item banks was simulated, and various IRT models were applied and compared.SubjectsThe original data were collected as part of the NCI-funded Quality of Life Evaluation in Oncology (Q-Score) Project. A total of 1,714 patients with cancer or HIV/AIDS were recruited from 5 clinical sites.MeasuresItems from 4 HRQOL instruments were evaluated: Cancer Rehabilitation Evaluation System–Short Form, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy and Medical Outcomes Study Short-Form Health Survey.Results and conclusionsFour lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed.

Measuring the quality of Patients’ goals and action plans: development and validation of a novel tool

BackgroundThe Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F), an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs) with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed.This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care.MethodsWe will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN) leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery.DiscussionMost research examining feedback to improve provider and facility performance lacks a detailed understanding of the elements of effective feedback. This research will highlight the elements most commonly used at high-performing facilities and identify additional features of their successful feedback strategies not previously identified. Armed with this information, practices can implement more effective A&F interventions to improve quality of care.

Fostering students’ reflection about bias in healthcare: Cognitive dissonance and the role of personal and normative standards

OBJECTIVES: To examine the relationship between a global measure of Medicare program familiarity and a broad set of measures of actual and perceived healthcare access.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

Identifying impairments in the capacity to make and execute decisions is critical to the assessment and remediation of elder self‐neglect. Few capacity assessment tools are available for use outside of healthcare settings, and none have been validated in the context of elder self‐neglect. Health and social services professionals are in need of validated tools to assess capacity for self‐care and self‐protection (SC&P) during initial evaluations of older adults with suspected self‐neglect syndrome. Currently, legal and medical declarations of incapacity and guardianship rely on clinical evaluations and instruments developed to assess only decision‐making capacity. This article first describes the conceptual and methodological challenges to assessing the capacity to make and execute decisions regarding safe and independent living. Second, the article describes the pragmatic obstacles to developing a screening tool for the capacity for SC&P. Finally, the article outlines the process for validation and field testing of the screening tool. Social services professionals can then use a valid and feasible screening tool during field assessments to screen for potential impairments in the capacity for SC&P in vulnerable older adults.