Leon McDougle

Development of an Educational Video to Improve Patient Knowledge and Communication with Their Healthcare Providers about Colorectal Cancer Screening

Abstract Background: Low rates of colorectal cancer (CRC) screening persist due to individual, provider, and system level barriers. Purpose: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. Methods: Focus groups of patients were conducted prior to the development of the CRC screening video, patient focus groups provided initial feedback about the video and medical personnel made recommendations prior to final video editing. Results: Patients identified CRC screening barriers and made suggestions about information to include in the video. Patients suggested using a doctor to state the importance of CRC screening, demonstrate how to complete the fecal occult blood test and that men and women from diverse ethnic groups and races could appear in the same video. Participants reviewed the video and thought it included their suggestions, was culturally appropriate and the information was easy to understand. Medical personnel suggested ways to improve the content and delivery of the information prior to final video editing. Discussion: Participants provided valuable information in the production of a video to improve patient knowledge and patient-provider communication about CRC screening. The video developed was based on the Protection Motivation Theory and addressed CRC screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. Translation to Health Education Practice: Educational videos can provide important information about CRC and CRC screening to average-risk adults.

Implicit Racial Bias in Medical School Admissions.

Problem Implicit white race preference has been associated with discrimination in the education, criminal justice, and health care systems and could impede the entry of African Americans into the medical profession, where they and other minorities remain underrepresented. Little is known about implicit racial bias in medical school admissions committees. Approach To measure implicit racial bias, all 140 members of the Ohio State University College of Medicine (OSUCOM) admissions committee took the black–white implicit association test (IAT) prior to the 2012–2013 cycle. Results were collated by gender and student versus faculty status. To record their impressions of the impact of the IAT on the admissions process, members took a survey at the end of the cycle, which 100 (71%) completed. Outcomes All groups (men, women, students, faculty) displayed significant levels of implicit white preference; men (d = 0.697) and faculty (d = 0.820) had the largest bias measures (P < .001). Most survey respondents (67%) thought the IAT might be helpful in reducing bias, 48% were conscious of their individual results when interviewing candidates in the next cycle, and 21% reported knowledge of their IAT results impacted their admissions decisions in the subsequent cycle. The class that matriculated following the IAT exercise was the most diverse in OSUCOM’s history at that time. Next Steps Future directions include preceding and following the IAT with more robust reflection and education on unconscious bias. The authors join others in calling for an examination of bias at all levels of academic medicine.

Survey of care for the underserved: a control group study of practicing physicians who were graduates of The Ohio State University College of Medicine premedical postbaccalaureate training program.

Purpose Multiple publications describe short- term and intermediate outcomes of premedical postbaccalaureate programs (PBPs). However, the authors could find no control group studies reporting the service provided by graduates of PBPs to patients who are medically indigent (e.g., on Medicaid or uninsured) and/or poor. The authors explored the relationship between successful completion of a midwestern PBP and providing care for the underserved. Method In 2008, the authors surveyed 1996-2002 graduates of The Ohio State University College of Medicine who had been in practice for at least one year about their current practice population. The authors compared two groups: (1) physicians who completed the PBP and (2) a stratified random control group of physicians who graduated from the same medical school, in the same graduating classes, but did not participate in the PBP. Results The survey return rate was 70.9% (73/103). Findings suggest that PBP graduates were more likely to be practicing medicine in a federally designated underserved area (29.4% versus 5.1%, P < .009) or providing service where 40% or more of the patients were medically indigent or poor (67.6% versus 33.3%, P < .003). PBP graduates were also more likely to be volunteering their services to patients who were indigent (47.1% versus 10.3%, P < .001). Conclusions This is likely the first control group study demonstrating the increased likelihood of graduates of a PBP providing health care to patients who are medically indigent and/or poor.

Evaluation of a new cultural competency training program: CARE Columbus.

PURPOSE This article reports the educational outcomes of the newly developed CARE (Cultural Awareness and Respect Through Education) Columbus cultural competency training program. METHODS Questionnaires were administered to course participants, who completed the 3-hour CARE Columbus cultural competency training program from March 17, 2006, to April 18, 2008. A pilot work site implementation questionnaire was also sent to a smaller sample of participants who completed the course. RESULTS The CARE Columbus cultural competency training received an overall program rating of 4.5 on a 5-point scale. Sixty-three percent (379 of 601) of the participants completed the program questionnaires. In addition, 55% (33 of 60) of the pilot work site implementation questionnaires were completed. CONCLUSION Initial evaluation of the CARE Columbus cultural competency training program appears to demonstrate its effectiveness in improving attitudes, knowledge, and skills. Expanded evaluation to include determination of how best to overcome work site implementation barriers is warranted. Future challenges include development of an optimal business plan to maintain sustainability and improve outreach of CARE Columbus and similar classroom style training programs.

Effectiveness of a premedical postbaccalaureate program in improving medical college admission test scores of underrepresented minority and disadvantaged students.

PURPOSE The purpose of this article is to share the procedures used to strengthen the Medical Pathways (MEDPATH) premedical postbaccalaureate program (PBP) to increase the chances of its students successfully graduating from medical school in four years. METHODS Subjects included students who matriculated into medical school between 1991-1999 (N = 72) following successful completion of the 12-month MEDPATH premedical PBP. Students who had passed the USMLE Step 1 on the first attempt were defined as successful and were compared to those who did not pass on their first attempt. Programmatic changes were implemented based on these findings, and outcomes were evaluated. RESULTS There was a significant improvement in total MCAT scores between pre-2003 (PBP entry year) participants (Mn = 20.73, SD = 3.10, N = 117) and post-2003 (PBP entry year) participants (Mn = 25.27, SD = 2.96, N = 37) (t = 7.86, df = 152, p < 0.001). MEDPATH premedical PBP coursework grade-point averages improved from 3.48 to 3.67 over the same time intervals. Diversity of program participants was maintained. CONCLUSION The enhanced MEDPATH premedical PBP appears to be producing underrepresented minority and disadvantaged medical students who are better prepared to succeed in medical school.

A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. Methods. We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996–2002). Results. The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. Conclusion. The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

Health Empowerment Technologies (HET): Building a Web- Based Tool to Empower Older African American Patient- Doctor Relationships

Responding to health and digital inequities among older African Americans, a customized web-based mobile health information intervention is being developed for this vulnerable group and their doctors as part of the Health Empowerment Technologies (HET) Project. The belief is an empowered patient-doctor relationship leads to more improved health outcomes than patient empowerment alone. Using health information technology to empower both older African Americans and their doctors by increasing health literacy and computer capacities of both is the major HET study aim. A focus group of older African American patients and one of their doctors yielded data to help build the HET. Thematic analysis of opinions and preferences about the content and structure of the HET revealed concordance and asymmetry among the patients and doctors. While challenges prevail in its construction, building this ethnicity-specific web-based health information technology presents the opportunity to integrate health information technology in clinical encounters for every patient.

In search of an ADHD screening tool for African American children.

PURPOSE Behavior rating scales have often been used to evaluate home and classroom behavior for children suspected of attention-deficit/hyperactivity disorder (ADHD). However, there is concern related to the use of behavior rating scales because African American boys and girls are twice as likely to be identified with ADHD behaviors by some of these instruments. This article serves as a brief reference for effectively evaluating African American children for ADHD. METHODS A MEDLINE search of peer reviewed literature published from 1970 to 2009 was conducted concerning the diagnosis of ADHD in African American children. RESULTS The majority of ADHD-specific behavior rating scales have face validity based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria. However, with few exceptions, developers of these instruments have failed to use national samples with significant numbers of ethnic minorities to ascertain that screening questions are in fact detecting equivalent behavioral abnormalities across cultures. Fortunately, efforts have been undertaken to validate and improve effectiveness of ADHD-specific behavior rating scales in ethnically diverse populations. CONCLUSION There are data supporting the use of the Terry and Vanderbilt Attention-Deficit/Hyperactivity Disorder scales for diagnosing ADHD in African American children. Further studies to develop and validate ADHD-specific behavior rating scales for African American children are needed.

Development and validation of the Patient Opioid Education Measure

Background Although there are screening tools to aid clinicians in assessing the risk of opioid misuse, an instrument to assess opioid-related knowledge is not currently available. The purpose of this study was to develop a content-valid, understandable, readable, and reliable Patient Opioid Education Measure (POEM). Methods Using concept mapping, clinicians caring for patients with chronic pain participated in brainstorming, sorting, and rating need-to-know information for patients prescribed opioids. Concept mapping analyses identified seven clusters addressing knowledge and expectations associated with opioid use, including medicolegal issues, prescribing policies, safe use and handling, expected outcomes, side effects, pharmacology, and warnings. Results The 49-item POEM was verbally administered to 83 patients (average age 51.3 ± 9.8 years, 77.1% female, 47.1% African American) taking opioids for chronic nonmalignant pain. Patients averaged in total 63.9% ± 14.3% (range 23%–91%) correct responses on the POEM. The POEM demonstrated substantial test-retest reliability (interclass correlation coefficient 0.87). The POEM had a mean readability Lexile (L) score of 805.9 ± 257.3 L (equivalent to approximately a US fifth grade reading level), with individual items ranging from 280 L to 1370 L. Conclusion The POEM shows promise for rapidly identifying patients’ opioid-related knowledge gaps and expectations. Correcting misunderstandings and gaps could result in safer use of opioids in a clinical care setting.

Strategies for Achieving Diversity through Medical School Admissions

Abstract:The relative lack of diversity in medicine is a rate limiting factor in efforts to eliminate health care disparities. Many medical schools struggle to matriculate student bodies that reflect the diversity of this country. Actively recruiting is one tactic to diversify a medical schools applicant pool, but in isolation is not enough. Our medical school admissions committee made a number of programmatic changes that contributed to our current compositional diversity that may be instructive to others. This report from the field on the experience of one U.S. medical school describes several admissions committee initiatives that can be undertaken to increase the yield of students from groups underrepresented in medicine who matriculate to medical school.