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   Table of Contents - Current issue
Coverpage
May-August 2021
Volume 4 | Issue 2
Page Nos. 33-90

Online since Wednesday, September 15, 2021

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PERSPECTIVE  

Don’t ignore the tipping point: A framework to fuel diversity, equity, and inclusion efforts in health-care sciences Highly accessed article p. 33
Catherine R Hoyt, Adam Cisroe Pearson, Jordan Skowronski, Stephanie Lancaster, Cristina Reyes Smith, Andy G. S. Daniel
DOI:10.4103/EHP.EHP_11_21  
In the United States, social determinants of health have resulted in inequities in health care, particularly for communities affected by systemic forms of racism and oppression. Health-care professionals are essential in assisting participation in the health-care system. Building a more diverse health-care workforce can expand access to care, improve the quality of care, and increase health equity. However, many health-care professions have struggled to effectively recruit and retain individuals from diverse backgrounds. In the field of occupational therapy, leaders in diversity, equity, and inclusion worked together to establish a framework with nationwide initiatives to effectively recruit and retain a workforce that is more representative of the communities, in which health-care professionals serve. The initiatives and framework outlined below can be replicated to advance efforts to increase diversity and create systems that address justice, equity, and inclusion.
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REVIEW ARTICLE Top

Ethnic and gender bias in objective structured clinical examination: A critical review p. 37
Iris C. I. Chao, Efrem Violato, Brendan Concannon, Charlotte McCartan, Sharla King, Mary Roduta Roberts
DOI:10.4103/EHP.EHP_2_21  
This critical review aimed to synthesize the literature and critique the strength of the methodological quality of current evidence regarding examiner bias related to ethnicity and gender in objective structured clinical examination implemented in health professions education. The Guidelines for Critical Review (GCR) was used to critically appraise the selected studies. Ten studies were retrieved for review. The overall quality of the papers was moderate. Two studies met all the criteria of the GCR, indicating stronger evidence of their outcomes. One of them reported ethnic and gender bias potentially existing, while another found only one examiner showing consistent ethnic bias. No systematic bias was found across the studies. Nonetheless, the possibility of ethnic or gender bias by some examiners cannot be ignored. To mitigate potential examiner bias, the investigation of implicit bias training, frame of reference training, the use of multiple examiners, and combination assessments are suggested.
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ORIGINAL ARTICLES Top

Beyond Flexner: A novel framework to implement the social mission of medical education p. 50
Fitzhugh Mullan, Malika Fair, Amir Meiri, Amy Zeidan, Sarah Diamond O’Donnell, Ashley Darcy-Mahoney, Asefeh Faraz Covelli
DOI:10.4103/EHP.EHP_6_21  
Purpose: Medical schools are uniquely positioned to contribute to the changing healthcare climate by increasing diversity in the healthcare workforce and addressing social determinants of health. The purpose of this study was to develop a framework for promoting social mission in medical education and develop case studies of medical schools that exemplify social mission. Materials and Methods: The research team and Advisory Committee first used an iterative process to identify eight core modalities as essential elements in the social mission of medical education. Each modality was supported by a literature review. Six schools were selected for their commitment to enhancing health equity. Interviews and focus groups were then conducted with school leadership, key faculty, students, and residents to learn about the social mission activities of the school and to evaluate the school’s commitment to the eight core modalities. Results: All schools selected for case studies integrated and actively engaged with all eight modalities: school mission, cultivation of the pipeline, student admissions, curricular structure and content, location of clinical experience, tuition management, mentorship, and postgraduate engagement. Each modality was utilized to advance the school’s social mission, demonstrating these modalities as a useful framework for promoting the social mission of medical education. Conclusion: The social mission modalities were developed to provide a tool for institutions to discuss, promote, or measure their social mission. This is ever-more important in the current healthcare climate and should be incorporated not only in medical education but also in all health professions education to build a culture of health.
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Student perceptions of iBooks as a clinical skills learning resource as compared to learning management software and an online video-hosting site p. 58
Jamie Perkins, Julie A Hunt, Stacy L Anderson, Undine Christmann, Philippa Gibbons, Seth Chapman, Jennifer T Johnson, John J Dascanio
DOI:10.4103/EHP.EHP_10_21  
Background: Learning resources to support clinical skills training can be delivered through a number of technology platforms, and listening to students’ preferences can be helpful in leveraging the use of technology in the laboratory. Objective: This study sought to compare students’ preference of clinical skills educational resources delivered by iBooks with that by a learning management system (Blackboard) and a video-hosting website (YouTube). Methods: A survey was conducted among veterinary students (n = 73) who completed their first year of clinical skills training. During the fall semester, they utilized 14 free iBooks, one per clinical skills laboratory, to prepare for fall laboratories. In the spring semester, their learning materials were provided on Blackboard and YouTube. At the end of the academic year, they were surveyed about their experiences and preferences. Results: Students reported a preference for the iBooks to the Blackboard and YouTube resources. This preference was the result of the convenience of having all resources on a single, well-organized platform and having access to iBooks after graduation as a perpetual reference, unlike Blackboard resources that students lose access to upon graduation according to the university policy. Students reported technological issues with iBooks, including downloading problems, at a similar rate as technological issues with Blackboard and YouTube. Conclusion: Educators should be guided by students’ preferences, provided the learning outcomes are similar, when selecting platforms for providing student educational resources. Although the iBooks seem preferable, additional research is necessary to understand how students use the iBooks and how that use impacts their clinical skills course performance.
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COVID bedfellows: Combining clinical skills and anatomy laboratories in the DVM curriculum p. 70
Erin D Malone, Abby L Brown, Susan J Spence
DOI:10.4103/EHP.EHP_9_21  
Background: Prior to the fall of 2020, clinical skills and anatomy were considered separate courses with minimal overlap other than being offered to the same cohort of students. We had included clinical skills practice in anatomy labs on an intermittent and variable basis. Many of the skills were included only if time and faculty or staff availability permitted. The coronavirus disease 2019 (COVID-19) pandemic made us think differently, particularly as the anatomy space was one of our largest rooms. Methods: Anatomy and clinical skills shared space and content during the 2020–2021 school year in an effort to meet physical distancing and other biosafety requirements required by the state and University. Results: Students were maintained in a single space and were engaged for a longer period of time, making their commute and biosafety steps worthwhile while simultaneously opening up other spaces for distanced teaching needs. The goal of one skill/day for motor skill learning was maintained despite a challenging laboratory teaching schedule. Certified veterinary technicians taught both the anatomy and the skills portion, showcasing the value of their training and freeing faculty for other responsibilities. Conclusion: This teaching and learning combination led to an enhanced understanding of procedure-related anatomy; direct anatomy application to veterinary work; opportunities for recall, transfer, and supervised practice; and optimized staff and space utilization.
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Multiple mini-interview for undergraduate allied health programs in Singapore p. 74
Meredith T. L. Yeung
DOI:10.4103/EHP.EHP_15_21  
Aims: To investigate the acceptability and feasibility of a four-station multiple mini-interview (MMI) model for admission selection into the four allied health undergraduate programs in Singapore. Methods: From 2015 to 2017, applicants to the four allied health undergraduate programs (physical therapy, occupational therapy, diagnostic radiography, and radiation therapy) at a university in Singapore underwent a four-station MMI. In 2017, interviewers of the MMI were polled using a 7-point Likert scale survey. Descriptive statistics were performed to analyze the quantitative portion of the survey, while content analysis and thematic description were applied to the qualitative data. Results: Data was collected from 79 interviewers. The majority agreed that the MMI was a fair process for applicants (83.5%), a good way of assessing interest and potential to become healthcare professionals (78.5%), and tested more aspects of the applicants than the traditional interviews (72%). They concluded that the MMI format was structured, objective, rigorous, unbiased, and assessed a valid range of competencies (67%). Conclusion: This study assessed and established the acceptability and feasibility of the MMI for undergraduate admissions to the allied health programs in Singapore.
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Tracheostomy: A shift in paradigm from a simple bedside procedure to a potential source of spread of COVID-19 p. 79
Sneha Nagendra, Sandeep Trehan, Ridhima Kaul
DOI:10.4103/EHP.EHP_17_21  
Introduction: Tracheostomy is defined as the creation of stoma at the skin surface that leads into the tracheal lumen. Tracheostomy in critically ill patients is usually performed in order to assist in weaning of prolonged ventilation. Objective: This article outlines the necessary changes to be adapted during the procedure of tracheostomy in the wake of COVID-19 pandemic. Methods: The methods suggested in the present study were obtained by performing a detailed observation of the many cases which were performed in a Tertiary Government Hospital in India. Results: The methods presented in this study were followed for every tracheostomy procedure performed since the emergence of COVID-19 pandemic. This resulted in reduced exposure to a great extent, the involved healthcare workers did not contact with COVID-19 infection. Conclusion: Modifications are necessary for the protection of healthcare workers in the absence of healthcare infrastructure like negative pressure/laminar flow operation theaters.
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SHORT COMMUNICATION Top

Qualitative provider experiences in a repurposed COVID-19 surge ICU: Forewarned is forearmed p. 84
Nandita R Nadig, Jillian Harvey, Andrew J Goodwin, Leslie Lenert, Dee W Ford
DOI:10.4103/EHP.EHP_12_21  
SARS-CoV-2 has engulfed our world over the course of the last year. Hospitals have experienced case surges and have had to innovate and adapt to care for these patients. This article represents qualitative experiences of providers working in a surge ICU. The codes, subsequent themes, and challenges identified here bring forth perspectives of providers working in surge ICUs and can serve as practical resource set as hospitals continue to surge based on the numerous waves of the pandemic. In light of these findings, it is critical to develop and evaluate resources to optimize provider well-being and workplace experiences.
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