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.
Optional After class:
IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx
- Supplementary activity to provide greater detail and context for the material covered in lecture. Recommended for students pursing certificate in quality and safety.
- GOAL: Improve understanding of culture of safety by providing additional examples.
- PS 104 lessons 2-3
- PS 202 Lesson 2
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 additional references
- For Washington students: WA state Health Care Landscape, section on ‘Safety Net’
- HRSA list of community health centers by state
- Health Reform and the Changing Safety Net in the United States
- American College of Emergency Physicians website ‘EMTALA’ (JAIME – EMAILED SESSION LEAD – NEED TO UPDATE LINK BROKEN)
- 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:
- Violence in the United States Status, Challenges and Opportunities, Sumner et al, JAMA 2015 Aug 4;314(5):478-88
- Goal: Apply the concepts of toxic stress and adverse childhood events to the cycle of interpersonal violence, and identify opportunities for clinician intervention.
- Context and Instructions: In this JAMA article, Sumner et al explore the epidemiology of interpersonal violence, the effect of childhood exposure to violence on lifetime risk of violence and adverse health, and opportunities for community and clinician intervention.
- The Lifelong Effects of Early Childhood Adversity and Toxic Stress, Shonkoff et al, Pediatrics Jan 2012, 129 (1) , focusing on pages e235-238, and figure 2 on page e23
- Goal: Describe the proposed pathophysiologic mechanisms of toxic stress’ effect on health across the lifespan and the mediating effect of known resilience factors.
- Context and Instructions: In this Pediatrics article, Shonkoff et al, delve into the science of toxic stress on the developing brain and the moderating effect of resilience factors. Based on this science, they propose an “ecobiodevelopmental framework” from which the clinicians of the future should approach primary care.
- NYT article on WA state resilient community success story
- Goal: compare and contrast effective community interventions to promote resilience in our region
- 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.
- Harvard Center on the Developing Child- neurobiology of toxic stress and resilience
- CDC ACEs Website: data, references
- ACES too high
- Robert Wood Johnson Self-Healing Communities– summary of the WA projects
- Nadine Burke-Harris Center for Youth Wellness
- Essentials for Parenting– tips for coaching parents
- Alaska Resilience Initiative
- Elevate Montana
- Prevent Child Abuse Montana
- Idaho Children’s Trust Fund
1) Review Ethics Key Terms
GOAL: Develop a preliminary grasp of using ethical frameworks that focus on social relations (see Ethics Worksheet Explained) and compare them to other ethical approaches covered thus far in the course.
Review these key ethics terms before turning to the video and reading:
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?
For further research on The Amish and healthcare, see S. Talpos’ “The Amish understand a crucial thing about modern medicine that most Americans don’t“.
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.
Social Ecological Model
McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care. A quick Google search for the social ecological model will reinforce how widely it has been adopted. There are numerous community, state, national and international organizations that utilize this model in their programs.
Think back to your session in immersion on the social history. How often do you think beyond the individual and interpersonal factors that influence you and your patients health?