Davis G. Patterson

Characteristics of health professions schools, public school systems, and community-based organizations in successful partnerships to increase the numbers of underrepresented minority students entering health professions education.

Purpose To identify characteristics of health professions schools, public schools, and community-based organizations in successful partnerships to increase the number of underrepresented minority students entering health professions. The Robert Wood Johnson Foundation and the W. K. Kellogg Foundation funded the Health Professions Partnership Initiative program developed from Project 3000 by 2000 of the Association of American Medical Colleges. Method Semi-structured interviews were completed with awardees and representatives of the funding agencies, the national program office, and the national advisory committee between the fall of 2000 and the summer of 2002. Site visits were conducted at ten sites, with representatives of partner institutions, teachers, parents, and children. Characteristics that supported and hindered development of successful partnerships were identified using an iterative qualitative approach. Results Successful partnerships included professional schools that had a commitment to community service. Successful leaders could work in both cultures of the professional and public schools. Attitudes of respect and listening to the needs of partners were essential. Public school governance supported innovation. Happenstance and convergence of interests played significant roles in partnership development. The most telling statement was “We did it, together.” Conclusions This study identifies characteristics associated with smoothly working partnerships, and barriers to successful program development. Successful partnerships can form the basis on which educational interventions are built. The study is limited by the definition of success used, and its focus on one funded program. The authors were unable to identify outcomes in terms of numbers of children influenced by programs or instances in which lasting changes in health professions schools had occurred.

American Indians and Alaska Natives: how do they find their path to medical school?

Background American Indians and Alaska Natives (AI/ANs) remain underrepresented in the medical profession. This study sought to understand the supports and barriers that AI/AN students encountered on their path to successful medical school entry. Method The research team analyzed qualitative semistructured, one-on-one, confidential interviews with 10 AI/AN medical students to identify salient support and barrier themes. Results Supports and barriers clustered in eight categories: educational experiences, competing career options and priorities, health care experiences, financial factors, cultural connections, family and friends, spirituality, and discrimination. Some of the most notable findings of this study include the following: (1) students reported financial barriers severe enough to constrain participation in the medical school application process, and (2) spirituality played an important role as students pursued a medical career. Conclusion Promoting AI/AN participation in medical careers can be facilitated with strategies appropriate to the academic, financial, and cultural needs of AI/AN students.

EMS medical direction and prehospital practices for acute cardiovascular events.

Abstract Objective. The purpose of this analysis was to determine whether there is an association between type of emergency medical services (EMS) medical direction and local EMS agency practices and characteristics specifically related to emergency response for acute cardiovascular events. Methods. We surveyed 1,292 EMS agencies in nine states. For each cardiovascular prehospital procedure or practice, we compared the proportion of agencies that employed paid (full- or part-time) medical directors with the proportion of agencies that employed volunteer medical directors. We also compared the proportion of EMS agencies who reported direct interaction between emergency medical technicians (EMTs) and their medical director within the previous four weeks with the proportion of agencies who reported no direct interaction. Chi-square tests were used to assess statistical differences in proportion of agencies with a specific procedure by medical director employment status and medical director interaction. We repeated these comparisons using t-tests to evaluate mean differences in call volume. Results. The EMS agencies with prehospital cardiovascular response policies were more likely to report employment of a paid medical director and less likely to report employment of a volunteer medical director. Similarly, agencies with prehospital cardiovascular response practices were more likely to report recent medical director interaction and less likely to report absence of recent medical director interaction. Mean call volumes for chest pain, cardiac arrest, and stroke were higher among agencies having paid medical directors (compared with agencies having volunteer medical directors) and agencies having recent medical director interaction (compared with agencies not having recent medical director interaction). Conclusions. Our study demonstrated that EMS agencies with a paid medical director and agencies with medical director interaction with EMTs in the previous four weeks were more likely to have prehospital cardiovascular procedures in place. Given the strong relationship that both employment status and direct interaction have with the presence of these practices, agencies with limited resources to provide a paid medical director or a medical director that can be actively involved with EMTs should be supported through partnerships and other interventions to ensure that they receive the necessary levels of medical director oversight.

Bioinformatics Education in High School: Implications for Promoting Science, Technology, Engineering, and Mathematics Careers

We report the effects of our Bio-ITEST teacher professional development model and bioinformatics curricula on cognitive traits (awareness, engagement, self-efficacy, and relevance) in high school teachers and students that are known to accompany a developing interest in STEM (science, technology, engineering, and mathematics) careers.

Health Information Technology Workforce Needs of Rural Primary Care Practices

PURPOSE This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT. METHODS Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires. FINDINGS EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas. DISCUSSION/CONCLUSIONS Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations.

Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

Abstract Objectives. To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. Methods. In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel. Results. A total of 1,292 providers responded to the survey, for a response rate of 67%. EMS scope of practice interventions varied by EMT personnel level, with the proportion of authorized interventions increasing as expected from EMT-Basic to EMT-Paramedic. Seven of eight statistically significant associations indicated that EMS agencies in urban settings were less likely to authorize interventions (odds ratios <0.7) for any level of EMS personnel. Based on the subset of six statistically significant associations, fire department–based EMS agencies were two to three times more likely to authorize interventions for EMT-Intermediate personnel. Volunteer EMS agencies were more than twice as likely as nonvolunteer agencies to authorize interventions for EMT-Basic and EMT-Intermediate personnel but were less likely to authorize any one of the 11 interventions for EMT-Paramedics. Greater medical director involvement was associated with greater likelihood of authorization of seven of the 18 interventions for EMT-Basic and EMT-Paramedic personnel but had no association with EMT-Intermediate personnel. Conclusions. We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department–based/non–fire department–based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS providers and offer important information for the transition towards the implementation of a national scope of practice model.

The Constraints of Innovation

While this “in” joke from the gay community pokes fun at the speed with which lesbians are said to meet and set up house together, it serves to illustrate that the career trajectories of same-sex relationships tend to differ substantially from those of heterosexual couples. Despite the similarities of all couple relationships and increasing efforts from the general and gay press to normalize what are often referred to as “alternative” family forms, gay and lesbian couple relationships are still, by and large, creative enterprises carried out under unconventional circumstances.

Supports and Obstacles in the Medical School Application Process for American Indians and Alaska Natives

Purpose. This study examines how a wide range of supports and obstacles are associated with the medical school admissions process of American Indians and Alaska Natives (AI/ANs), an under-studied population. Method. All AI/AN applicants to the University of Washington School of Medicine during the 2002–2004 admissions cycles were sent a mail-in survey with numerical and open-ended items. We analyzed admissions data for all 107 applicants and data on supports and obstacles for 34 survey respondents. Results. Compared with respondents accepted by at least one medical school, rejected respondents were older, more often were parents, submitted fewer applications, and reported receiving less support for the medical school application process. Obstacles included difficulty with the Medical College Admission Test, insufficient finances, and poor information about the process. Conclusion. A conceptual framework that considers both supports and obstacles in the medical school application process will improve our understanding of the needs of AI/AN applicants.

Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine

INTRODUCTION Opioid use disorder is a serious public health burden, especially throughout rural America. Although efforts have been made to increase the availability of buprenorphine (an office-based medication-assisted treatment), more than 60% of rural counties in the U.S. lack a physician with a Drug Enforcement Administration waiver to prescribe it. METHODS This study surveyed all rural physicians with a Drug Enforcement Administration waiver in 2016 to prescribe buprenorphine for opioid use disorder in the U.S. and asked about physicians demographics, prescribing practices, and barriers to prescribing buprenorphine for treatment of opioid use disorder. RESULTS Although 89.4% of physicians reported having prescribed buprenorphine for opioid use disorder, only 56.2% were currently accepting new patients for treatment. Physicians with a 30-patient waiver were treating, on average, 8.8 patients, but 53% were not treating any patients. Those with a 100-patient waiver were treating, on average, 56.9 patients. Significant practice variations were found throughout the U.S. by Census Division; more physicians in the Pacific Census Division accepted their own patients for treatment with buprenorphine whereas more physicians in the New England Census Divisions accepted patients of other clinicians in their practice. Although most physicians accepted private insurance, significantly fewer physicians in the East South Central and West South Central Census Divisions accepted Medicaid. CONCLUSIONS These findings suggest that without incorporating information about whether or not physicians are accepting new patients, how many patients are being treated, and which patients and reimbursements are accepted, estimating the supply of buprenorphine treatment services using the Drug Enforcement Administration waivered physicians list will overestimate treatment availability. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

Participation in enrichment programs and its effect on interview scores of applicants to the University of Washington School of Medicine.

Enrichment programs for underrepresented-minority (URM) and disadvantaged students provide a variety of motivational, academic, and research opportunities. Many enrichment programs take place in medical schools, where one might expect the students to pick up skills and knowledge that could give them a competitive advantage during their medical school admission interviews. To test this, the authors surveyed the 227 URM students who were interviewed at the University of Washington School of Medicine in 1993, 1994, and 1995, dividing them into two groups: 97 students who had participated in enrichment programs and 130 students who had not. The authors compared the interview scores of the two groups. Participation in an enrichment program was not associated with better interview scores. Being a woman and having strong MCAT verbal reasoning scores were the only variables that had statistical significance for the prediction equation of the interview score.