Tiffany B. Kindratt

Food allergy training event for restaurant staff; a pilot evaluation.

A previous cross-sectional survey highlighted that restaurant staff in Brighton had gaps in their knowledge of food allergy, which could lead to the provision of unsafe meals to food-allergic customers. A food allergy training event was developed by a multi-disciplinary team (health service researcher, clinician, teacher and patient group representative) to equip restaurant staff with the knowledge and skills necessary to safely serve food-allergic customers. This evaluation summarises the training event’s impact on participants’ knowledge of food allergy and their satisfaction with the event.No attendee had previously attended any formal training on food allergy. The percentage of participants who answered all true-false questions correctly increased from 82% before the training event to 91% afterwards. The percentage of participants who were able to name at least three common allergens increased from 9% to 64%. Both quantitative and qualitative feedback was positive.Restaurant staff require a good understanding of food allergy to ensure that food-allergic customers are kept safe, and their restaurants operate within the law. This food allergy training event improved participants’ absolute knowledge of food allergy, and attendees changed practice. Recommendations are made which could improve the impact and uptake of future food allergy training events.

Disparities in Preventive Health Behaviors Among Non-Hispanic White Men Heterogeneity Among Foreign-Born Arab and European Americans

The objectives of this study were to estimate and compare the age-adjusted prevalence of not receiving a flu vaccine, pneumonia vaccine, or prostate cancer screening among U.S.- and foreign-born White men by region of birth (Europe/Russia and the Arab Nations) and examine these associations while controlling for potential confounders. Twelve years of restricted data from the National Health Interview Survey (NHIS) including 91,636 U.S.- and foreign-born men were used. Chi-squares were used to compare descriptive statistics, and odds ratios (ORs; 95% confidence intervals [CIs]) were used for inferential statistics. In crude and adjusted analyses, foreign-born Arab American men were less likely to report receiving a flu (OR = 0.38; 95% CI = 0.21, 0.67) and pneumonia (OR = 0.33; 95% CI = 0.16, 0.70) vaccine compared with U.S.-born White men. There were no statistically significant differences for PSA testing between Arab American and White men. This national study examining uptake of flu and pneumonia vaccines suggests estimates are lower for foreign-born Arab American men compared with U.S.-born White men. Future studies should collect qualitative data that assesses the cultural context surrounding prevention and screening behaviors among Arab Americans.

'Don't be scared': Demystifying statistics in postgraduate medical education

Statistics can be a frightening concept for students enrolling in postgraduate medical courses. Research has shown that students have anxiety towards statistics instruction.1–3 Reviewing and interpreting statistics are important skills that future physicians and other medical professionals must acquire in order to adhere to evidence-based practice guidelines. In order to demystify medical statistics internationally, we evaluated and compared the statistics curriculum at the University of Texas Southwestern (UTSW) Medical Center’s Family Medicine Residency in Dallas, Texas and Brighton & Sussex Medical School’s (BSMS) Division of Medical Education in Brighton, England. Four objectives of this study were to: 1) measure changes in preand post-knowledge and anxiety of statistics in BSMS Research Methods & Critical Appraisal (MDM10) and Essential Statistics for Research (MDM 66) modules; 2) measure changes in preand post-knowledge and anxiety of basic statistics in a UTSW Family Medicine Residency didactic class block; 3) compare differences in statistics anxiety and knowledge gained between different learning settings; and 4) obtain student and resident feedback. We developed three statistics training courses and tailored them to meet curriculum needs. Data were collected from March to May 2012 from postgraduate students at BSMS and from December 2013 to January 2014 at UTSW. Students in MDM10 (n=12) completed a pre-knowledge and anxiety test prior to the statistics lecture on Day 4. Students rated their perceptions of knowledge on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). At the end of the module, students completed a post-test to determine knowledge gained and satisfaction. Students enrolled in MDM66 (n=11) completed a pre-test rating their perceptions of advanced statistics knowledge on the same 5-point Likert scale on the first day of their module. At the end of the week, students completed a post-test to determine knowledge gained and they provided feedback on course satisfaction. Family Medicine physician residents at UTSW (n=23) reported their perceptions of basic statistics and SPSS knowledge and anxiety before and after attending a 2-hour didactic and computer lab session. Mean changes in self-reported knowledge were measured using Wilcoxon-signed rank tests calculated for each cohort. Significant differences between statistics courses were determined using a Kruskal-Wallis test. The study was exempted from ethics review board approval because it was not deemed human subjects research. We found that MDM10 students and UTSW residents were most anxious about their ability to plan a study using statistics means (2.83 and 2.70, respectively) and interpret/explain results of their statistical analysis means (2.83 and 2.61, respectively). Medical learners showed a significant improvement in knowledge of basic statistics in MDM10 (P=0.041), MDM66 (P=0.027) and UTSW Residency (P<0.01) courses. There were no significant differences in statistics knowledge or anxiety by geographic location or course. Students reported that the instruction was well-paced and examples were helpful but wanted more examples for each statistical test. Residents reported that the training was very helpful, they liked using data from an actual on-going study and desired training earlier in their residency. We found that students and residents had a slight to moderate level of anxiety towards learning statistics. Medical learners in all three courses showed significant improvement in perceived statistical knowledge, with the greatest improvement among UTSW Family Medicine residents. Situational, dispositional and environmental factors can all play a role in statistics anxiety.4 Several tools have been developed to measure these learning barriers. However, there remains a gap in the literature which future studies can explore examining whether these factors play a role in postgraduate medicine. Our study can be replicated in other medical education settings to find ways to improve the statistics curriculum and reduce statistical anxiety among medical learners. We plan to enhance our curricula in order to address the knowledge and skills barriers and ‘demystify’ statistics for medical learners once and for all.

Community action research experience (CARE): Training family physicians in community based participatory research

Family physicians are optimal candidates to improve access to care and reduce health care inequalities. The Accreditation Council of Graduate Medical Education (ACGME) requires a structured curriculum in which family medicine (FM) residents address population health [1]. Current models of FM training may not adequately prepare physicians to partner with and impact the health of their communities. One way to respond to this shortfall is by training FM residents in community-based participatory research (CBPR). CBPR is an approach that equitably involves community members, organisational representatives, and researchers in all aspects of the research process. Community partners contribute expertise and shared decision-making with researchers [2]. The aims of CBPR are to: increase understanding of a given phenomenon; integrate the knowledge gained with interventions; and change policy to improve the health and quality of life of community members [2]. To achieve successful outcomes, CBPR projects require trained physicians and researchers. An optimal time for training is during residency; however, due to the complexity of the residency structure, it is challenging for programmes to incorporate CBPR in their curriculum. We developed a longitudinal community action research experience (CARE) to train FM residents in CBPR skills to increase their community engagement and interests in practising in community-based underserved settings after graduation. In this article, we provide an overview of the CARE curriculum and evaluate the impact of the programme based on residents’ feedback and accomplishments. Methods

Teaching primary care providers about parent-provider literacy communication

Dear Editor, Reach Out and Read (ROR) encourages paediatric literacy discussions during well-child (birth to five-year old) visits in the United States [1]. The programme includes: integration of book delivery; delivery of anticipatory guidance to parents on dialogic reading; assessment of developmental literacy milestones; and modelling reading by volunteers in clinic waiting rooms [1]. The aim is to improve language skills, cognitive skills and school readiness through shared reading between parents and children. However, primary care (PC) providers are not adequately prepared to communicate with parents about literacy during well-child visits. Rosenthal et al. demonstrated that an intervention utilising didactic sessions, roleplaying and peer feedback can improve Family Medicine (FM) residents’ knowledge, skills and attitudes towards paediatric literacy concepts [2]. Although these training methods can be effective, more experiential training on paediatric literacy promotion and parent-provider literacy communication is needed for PC providers. We pilot-tested a curriculum to improve medical learners’ ability to incorporate paediatric literacy communication into well-child visits. FM residents (n = 30), physician assistant (PA) students (n = 42) and medical students (n = 20) participated in a curriculum of: (1) online training; (2) service-learning opportunities at a local homeless shelter participating in ROR [3]; and (3) objective structured clinical exams (OSCEs) we developed to practise parent-provider literacy communication skills. Standardised patients (6 months–5 years) and standardised patient caregivers (SPCs) were recruited and trained. Stations represented children accompanied by their mother, father, grandmother and non-relative caregivers. Each learner completed two stations: (1) infants/toddlers (<2 years) and (2) pre-schoolers (2–5 years). They were evaluated on their abilities to instruct the SPC how to offer books to patients, provide anticipatory guidance and demonstrate basic communication skills. Learners’ selfperceived knowledge, attitudes and satisfaction were collected preand post-curriculum. We found significant improvements in knowledge of activities which foster a child’s reading/writing skills (p = .0074) and attitudes towards assessing literacy and providing parents with anticipatory guidance (p < .0001). All learners (100%) gave at least one recommendation on age-specific reading and books during the OSCE stations. Few learners instructed SPCs to use dialogic reading skills such as pointing at objects (27.3%; ages 6–12 months) and letters in the child’s name (30.8%; ages 4–5 years). Most (63.6%; ages 2–3 years) instructed the SPC to let the SP choose which book to read and were willing to read the same book multiple times. Only 9.1% recommended nursery rhyme books as age-appropriate reading material for the youngest SP (6–12 months). Despite limitations in skills, all learners (100%) spoke slowly and used words that caregivers could understand for all age groups. Our curriculum was effective at improving paediatric literacy knowledge and attitudes. Previous studies evaluating paediatric literacy training among FM residents [2] have had similar outcomes. Our curriculum added to this by measuring anticipatory guidance and communication skills using paediatric SPs and SPCs. We hope to develop additional OSCE stations to include stations where the SPC has more than one child or needs language support from an interpreter. While our unique population of medical learners may not be the similar to other universities, we hope that sharing our results can raise awareness of the importance of integrating early childhood literacy discussions into well-child visits from birth to 5 years. Yours sincerely.