Author Archives: mspin

Community Visit

Complete the readings

Watch: Entering and Exiting Communities

  • Whether you’re working with a partner, conducting a site visit, doing research, or getting to know folks in a community, it helps to think through the before, during, and after to create a comfortable, safe, and reciprocal experience

READ: Collins, Janet, and Jeffrey P. Koplan. “Health impact assessment: a step toward health in all policies.” Jama 302.3 (2009): 315-317.

  • Instructions: Review social and structural determinants of health and how they apply to communities and health outcomes.

Review Community Visit Materials on Canvas

Supplemental readings and resources (not required)

Creating A Culture of Safety

1) Watch the video: “Building a psychologically safe workplace” (TED talk by Amy Edmonson).

GOAL: Develop awareness of psychological safety and its importance in teamwork.

In high-functioning teams, every member feels able to disclose errors, near-misses, or unsafe situations without fear of punishment or retaliation. Creating this culture of safety requires openness, trust, and leadership. As you watch this video, consider situations that you have witnessed in your clinical experiences. How would you characterize the psychological safety in these environments?

The Medical Safety Net with Health Policy

1. READ: The “Executive Summary” for Community Health Centers: Recent Growth and the Role of the ACA

  • NOTE: the longer “Issue Brief” contains additional details but is NOT required reading
  • GOAL: Provide additional data regarding community health centers, populations served, and funding received.
  • INSTRUCTIONS: Read the following summary for basic introductory information regarding community health centers. Pay particular attention to the mechanisms for funding and access.

 

Optional Video

 

Optional additional references

Aftermath

1) Read Article

Read the The Art of Constructive Worrying

GOAL: Explore the idea of aftermath of medical error on an individual provider in terms of both sentinel events and smaller daily “mistakes.”  Consider how to channel this distress into productive outlets, for example, through constructive worrying.

Context and Instructions: Read article to begin to appreciate the effect medical errors can have on providers and get introduced to a way of thinking of how to support ourselves and colleagues who experience the aftermath of a medical error.

2) Read Article

Read Debriefing for clinical learning

GOAL: Gain more familiarity with tool of debriefing especially as it might pertain to the aftermath of an adverse clinical event.

Context and Instructions: Read article to learn about the definition of debriefing, the components of debriefing, and special considerations.

Optional Activities:

1) Read Article

Read The Emotional Impact of Errors on Practicing Physicians in the United States and Canada

GOAL: Have access to primary data on the emotional impact of errors on providers.

Context and Instructions: Review a survey completed by 3,171 of the 4,990 eligible physicians in internal medicine, pediatrics, family medicine, and surgery (64% response rate) on the emotional impact of errors on practicing physicians.

2) IHI Online Module

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

  • PS 105 Lessons 1-4

GOAL:  Recognize approaches to responding to an adverse event and the impact of adverse events on caregivers.

Context and Instruction: This supplementary activity will offer further context on the patient apology, responding to an adverse event, and the impact of adverse events on caregivers as the second victim.

PICO Questions and Finding Medical Information

1) Watch PICO video

GOAL: Differentiate a PICO question from a background question.

Instructions: Actively watch video to help understand the components of a PICO question and how you might employ these questions in clinical practice.

2) Watch Finding Medical Information video

GOAL: Understand how to access different sources of information depending on your question.

Instructions: Actively watch video to help understand differences between types of questions and available resources to answer them.

3) Write some PICO questions of your own 

Develop 2-3 PICO question of your own to share in class tomorrow. It may help to think about a patient you have seen or a case discussed during Foundations or EHM so far. You can use the PICO diagramming tool to record your questions.  Be prepared to share and discuss.

 

Adverse childhood experiences and trauma informed care

Activities:

  1. Watch Nadine Burke Harris’s TED talk that introduces key concepts about Adverse Childhood Experiences and how they impact health.
    • Goal: Define the scope and frequency of adverse childhood experiences (ACE) and toxic stress, the connection to illness across the lifespan, and opportunities for clinician intervention
    • Context and Instructions: Dr. Nadine Burke Harris explains how incorporating an understanding of the frequency and effects of adverse childhood experiences (ACES) can impact medical practice.

2. Then READ EITHER:

OR

Optional readings:

  1. NYT article on WA state resilient community success story
    • Goal: compare and contrast effective community interventions to promote resilience in our region
  1. Original ACEs study: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245–258. doi:10.1016/s0749-3797(98)00017-8. 
    • Goal: For students who want to read the Kaiser study that introduced the idea of ACES and the impact on health.  A caveat that some language in this original paper (“family dysfunction”) would not be used in the trauma informed care environment that this work ultimately produced.

Additional Resources:

Community Engagement in Population Health

1. Read Cultures of engagement: The organizational foundations of advancing health in immigrant and low-income communities of color. Bloemraad I, Terriquez V. Soc Sci Med. 2016;165:214-222. PMID: 26898114.

This article presents an overview of the mechanisms by which community-based organizations can contribute to community well-being. Consider the implications for local communities you have worked in, and think about questions you’d like to ask panel members about their work.

Relational Ethics

This module will focus on ethical reasoning that relies on Social Relations:

1) Review Ethics Key Terms

GOAL: Familiarize yourself with and review these key ethics terms before turning to the video and reading:

  1. Care Ethics
  2. Communitarianism
  3. Interdependency

2) Watch video of Carol Gilligan on Moral Development and Care Ethics.

GOAL: Understand the basics of care ethics and how it might apply to the clinical setting.

Consider what is different about the approach that Gilligan is suggesting (i.e. a relational or Care Ethics based approach) from what you typically think of in terms of your ethical obligations as physicians.

3) Read Baby Aaron and the Elders by Ellen Wright Clayton and Eric Kodish

GOAL: Consider what you learned from Gilligan’s video and the above ethics key terms in this complex case of refusal of life sustaining treatment (LST).

Consider this is just one instance among a myriad of different clinical-community interactions. It will help us to begin to see the importance and sometimes the difficulty of respecting and valuing different community-based and relationship-based values and beliefs.

Have you ever found your own personal and community-based beliefs to be in tension with the norms of the institution of medicine?

 


You can also find substantial research on many diverse communities of Americans here in a “Diversity Toolkit” created by Cleveland Clinic: https://my.clevelandclinic.org/-/scassets/files/org/about/diversity/2016-diversity-toolkit.ashx.

Systems Engineering

IHI online open school. Optional assignment: Students complete the online curriculum and assessment for certificate program.  To provide greater detail and context for the material covered in class.  Recommended for students pursing a certificate in quality and safety.

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

  • Define principles of human factors design. Understand how technology can help mitigate against medical error.
    • PS 103 lessons 2-3