Jay B. Morrow

A validated cultural competence curriculum for US pediatric clerkships

OBJECTIVE A 2006 national survey of pediatric clerkship directors revealed that only 25% taught cultural competence, but 81% expressed interest in a validated cultural competence curriculum. The authors designed and evaluated a multi-modality cultural competence curriculum for pediatric clerkships including a validated cultural knowledge test. METHODS Curriculum content included two interactive workshops, multimedia web cases, and a Cultural and Linguistic Competence Pocket Guide. Evaluation included a student satisfaction survey, a Nominal Technique Focus Group, and a validated knowledge test. The knowledge test comprised 6 case studies with 49 multiple choice items covering the curricular content. RESULTS Of 149/160 (93%) students who completed satisfaction surveys using a 5-point Likert scale, >82% strongly agreed or agreed that the curricular intervention was a meaningful experience (93%), increased their understanding of the culture of medicine (91%), increased their knowledge of racial and ethnic disparities (89%) and core cultural issues (91%), and improved their skills in working with interpreters (90%) and cross-cultural communication (82%). Top strengths identified by a focus group (34 students) included learning about interpreters, examples of cultural practices, and raised cultural awareness. Pre- and post-knowledge test scores improved by 17% (p<.0001). After six administrations, the test achieved the target reliability of .7. CONCLUSIONS The authors successfully designed and validated a practical cultural competence curriculum for pediatric clerkships that meets the need demonstrated in the 2006 national survey. PRACTICE IMPLICATIONS This curriculum will enable pediatric clerkship directors to equip more graduates to provide culturally sensitive pediatric care to an increasingly diverse US population.

‘Sedentary behaviour counselling’: the next step in lifestyle counselling in primary care; pilot findings from the Rapid Assessment Disuse Index (RADI) study

Background Accumulating evidence emphasises a relationship between prolonged sitting and increased risk for cardiometabolic disorders and premature death irrespective of the protective effects of physical activity. Primary care physicians have the potential to play a key role in modifying patients’ sedentary behaviour alongside physical activity. Methods A pilot study examining sedentary behaviour and physical activity counselling in a primary care clinic. A total of 157 patients completed a detailed survey related to lifestyle counselling received from their primary care physician. We analysed these responses to describe counselling practices within the 5A framework, and to examine correlates (ie, patients’ demographics, sedentary behaviour and physical activity and clinical variables) related to receiving counselling. Results A total of 10% received general advice to decrease sitting time, in comparison with 53% receiving general physical activity counselling. None, however, received a written plan pertaining to sedentary behaviour whereas 14% received a written physical activity prescription. Only 2% were provided with specific strategies for sedentary behaviour change in comparison with 10% for physical activity change. Multivariable analysis revealed that patients who were obese were more likely to receive counselling to decrease sitting (OR=7.0; 95% CI 1.4 to 35.2). In comparison, higher odds for receiving physical activity counselling were associated with being younger, aged 40–59 years (OR=2.4; 95% CI 1.1 to 5.4); and being a non-smoker (OR=6.1; 95% CI 1.3 to 28.4). Conclusions This study is the first to assess sedentary behaviour counselling practices in primary care and such practices appear to be infrequent. Future research should attempt to establish a ‘knowledge base’ to inform development of sedentary behaviour interventions, which should be followed by testing feasibility, efficacy, and subsequent effectiveness of these programmes in a clinical setting.

Impact of Risk Assessment and Tailored versus Nontailored Risk Information on Colorectal Cancer Testing in Primary Care: A Randomized Controlled Trial

Background: Colorectal cancer screening is effective but underused. Guidelines for which tests are recommended and at what intervals depend on specific risks. We developed a tablet-based Cancer Risk Intake System (CRIS) that asks questions about risk prior to appointments and generates tailored printouts for patients and physicians summarizing and matching risk factors with guideline-based recommendations. Methods: Randomized controlled trial among patients who: (i) used CRIS and they and their physicians received tailored printouts; (ii) used CRIS to answer questions but received standard information about cancer screening while their physicians received a standard electronic chart prompt indicating they were age-eligible but not currently adherent for colorectal cancer screening; or (iii) comprised a no-contact group that neither used CRIS nor received any information while their physicians received the standard prompt. Participation in testing was assessed via electronic medical record at 12 months. Results: Participation in any colorectal cancer testing was three times higher for those who used the CRIS and received any printed materials, compared with no-contact controls (47% vs. 16%; P < 0.0001). Among CRIS users ages 50 and older, participation in any testing was higher in the tailored group (53% vs. 44%, P = 0.023). Conclusion: Use of CRIS and receipt of any information facilitated participation in testing. There was more testing participation in the CRIS-tailored than nontailored group. Impact: Asking patients questions about their specific risk factors and giving them and their providers information just prior to an appointment may increase participation in colorectal cancer testing. Tailoring the information has some added benefit. Cancer Epidemiol Biomarkers Prev; 24(10); 1523–30. ©2015 AACR.

Tailored information increases patient/physician discussion of colon cancer risk and testing: The Cancer Risk Intake System trial

Assess whether receipt of tailored printouts generated by the Cancer Risk Intake System (CRIS) – a touch-screen computer program that collects data from patients and generates printouts for patients and physicians – results in more reported patient-provider discussions about colorectal cancer (CRC) risk and screening than receipt of non-tailored information. Cluster-randomized trial, randomized by physician, with data collected via CRIS prior to visit and 2-week follow-up telephone survey among 623 patients. Patients aged 25–75 with upcoming primary-care visits and eligible for, but currently non-adherent to CRC screening guidelines. Patient-reported discussions with providers about CRC risk and testing. Tailored recipients were more likely to report patient-physician discussions about personal and familial risk, stool testing, and colonoscopy (all p < 0.05). Tailored recipients were more likely to report discussions of: chances of getting cancer (+ 10%); family history (+ 15%); stool testing (+ 9%); and colonoscopy (+ 8%) (all p < 0.05). CRIS is a promising strategy for facilitating discussions about testing in primary-care settings.

Providing Access to Specialty Care for Severely Disabled Institutional Residents: An Academic Health Center Telemedicine Model

The UT Southwestern Virtual Wound Care Clinic provides care to disabled institutional residents in an urban setting. The program offers flexible financial mechanisms for residents of the facility to access specialty care. Telemedicine improves quality-of-life and reduces costs by minimizing patient transportation. The exchange of clinical knowledge benefits both parties.