Category Archives: Individuals

Socialization and Implicit Bias

Review the following terms from the EHM WordPress Lexicon. Identity, Implicit Bias, Cultural Competency and Narrative Humility.

Discover the basic tenets of socialization. Watch the following video to develop a basic understanding of socialization.

Socialization: Crash Course Sociology #14

 

Understand how bias is ubiquitous. Watch the following video to understand how bias is an everyday part of our lives.

“Are you biased? I am.” | Kristen Pressner | TEDxBasel

 

Read the systematic review and focus on the sections of “Background” (2-3) and “Existence of Implicit biases/stereotypes…” (13-14).   Gain an appreciation of how implicit bias can lead to direct and indirect consequences in patient care.

FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18:19. doi:10.1186/s12910-017-0179-8. 

 

Supplemental.

  1. Refresh your memory on how narrative humility can improve our experience with patients.  Reread the article from Immersion – The art of medicine – Narrative Humility.
  2. Learn basic first steps for recognizing bias in your communication and interaction with others. Read the last sections on “Checking Perception” and “Getting Competent – Communication in the Real World: An Introduction to Communication Studies. 2.4 Improving Perception: http://open.lib.umn.edu/communication/chapter/2-4-improving-perception/   

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.

Thinking Fast and Thinking Slow

This session begins an exploration of thinking about thinking.  Nobel laureate Daniel Kanhneman deserves credit for the title- he published Thinking, Fast and Slow in 2011.  In our quest to become master clinicians, it is paramount we explore all aspects of clinical reasoning.  This session introduces the thought process behind conscious and unconscious bias and how it may influence the way you think about clinical problems and patients.

A brief note on bias.  The Oxford English Dictionary (OED) defines bias as “Cause to feel or show inclination or prejudice for or against someone or something.”  As you read the below articles and participate in the in class discussion consider how these theories of thought contribute to how fast or slow you arrive at conclusions.

Over the course of EHM we will continuously refer to Type I and Type II thinking.  An understanding of these fundamental thought processes can improve not only your clinical reasoning but your interactions with patients and peers.

Actively watch this introductory video on Dual Process Theory. Compare and contrast system 1 and system 2. 

“Think Fast! Critical Thinking and Dual Process Theories.”

Read entire article, paying particular attention to the highlighted portions. Begin to think about how the 2 systems interplay in clinical decision making and how physicians must rely on both.

Croskerry P. A universal model of diagnostic reasoning. Acad Med. 2009;84:1022-8. Be sure to read the highlighted sections

Honoring the Individual: Narrative and Cultural Humility

This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.

To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan

This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.

The stigma of being young, black and Republican, by Kamaria Roberts

Watch this compelling YouTube video by Director Vivian Chavez.  Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.

Cultural Humility, by Vivian Chavez

Social Ecological Model

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?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)

Carrier Testing and Genetic Counseling

Start by WATCHING this video by Dr. Robin Bennett M.S., L.G.C., Ph.D. to gain a better understanding of various clinical and social aspects of genetic counseling: 

https://mediasite.hs.washington.edu/Mediasite/Play/42b4867d9fe14589838c9415498a19a11d

 

With this broader understanding in mind, let’s dig into the ethics of this area of medicine…

READ Genetic Screening by Burke, et al.  Focus on the content found on pages 154-156.

Optional Review the following key ethics terms:

 

If you’re interested in further investigation… (not required)

These two links are optional and are intended for the student who has prior experience with the topic and/ or a strong desire for additional information.

Also see “Carrier testing for Ashkenazi Jewish disorders in the prenatal setting” by Ferriera et al. This article was published in the American Journal of Obstetrics and Gynecology.  It is above the level of the average foundations phase student.

For more information about ethical issues around genetic testing in Ashkenazi Jewish populations read “A young couple tests compatibility” and then explore the Dor Yeshorim website.