Category Archives: Interactions

Interrupting and Responding to Bias

Goals:

  • Introducing concepts of ingroup, outgroup, and creating opportunities for positive exposure to individuals different from oneself.
  • Introduce (de)individuation and empathy as key factors in quality of care.

(1) WATCH: Verna Myers TEDTalk at “How to overcome our biases?  Walk boldly toward them.”

  • Verna Myers urges viewers to move beyond denying or suppressing bias, to employing strategies to alter perceptions of certain groups over time.

(2) LISTEN to the short podcast and read the accompanying article. “A Patient, Not a Person“: Medicine’s bad habit of dehumanizing patients.

  • Discussion with Adam Waytz about how physicians tend to dehumanize their patients over time and the consequences this can have on the care provided.

(3) READ the op-ed piece by Dr. Okwerekwu. “The patient called me ‘colored girl.’ The senior doctor training me said nothing.”

  • Read this post from STAT Newsthat describes a medical student’s experience with racist comments during her clinical training and how it felt when no one spoke out against it.

(4) READ the JAMA op-ed piece “Speak Up” by Dr. Merrill. 

  • Read this JAMA Piece of My Mind“Speak Up” which describes one physician’s experience with speaking up when witnessing micro-aggressions or biased comments or behavior in the clinical workplace.

(5) REVIEW “Tools for Responding to Bias” on the EHM WordPress site.

  • Read over methods for responding to witnessed bias. Consider how you might respond as a bystander or the person receiving the bias.

Geography and Health

In this session, we will consider how the environment influences the health of individuals and populations, and how the local geography of the place we live and the places we and others travel to can impact our well-being. The relationship between geography and health was recognized as far back as the time of Hippocrates, who stated that “airs, waters, and places” all had a significant impact on human health. In Week 1, we learned about the cholera outbreak in London in 1854, and how John Snow’s study of the homes of people who had died and where they got their water led to a ground-breaking understanding of how public health interventions can interrupt an epidemic.

Environmental health concerns often are areas where public health and policy are important tools, and progress in protecting health requires the concerted efforts of a large number of concerned stakeholders.

To gain an understanding of how the environment impacts health, please complete the following before class:

Activity 1:

As you view the report, CONSIDER…

  • What was the cause of the problem and why did it take so long to acknowledge there was a problem?
  • What role did physicians play in helping to identify and address the problem?
  • Who came together to make sure that the problem was recognized, investigated, and acted upon

Activity 2:

Activity 3:

  • After completing your pre-class assignment and considering the questions above, take our survey to identify the concerns of your class regarding geography and health, at the link below.
  • When you respond, try to use one-word answers if possible, as this will help us identify the concerns that appear most commonly.

Gender and Health

In this session, we will consider how the relationship between gender and health by examining the historical and present-day influences of sexism and cissexism on disparities in health status and care. Gender, like race, is considered a “master status” in US society: one of the first things we notice about someone is their gender and gender is central to our perceptions of self and our attribution of characteristics and qualities to others. Medicine is not immune to these social influences and in many ways, has perpetuated inequities based on gender. To gain an understanding of the relationship between gender and health, please complete the following before class. It is recommended that you read/watch and take notes as you complete the following three activities.

(1) WATCH: Toxic Masculinity In Boys Is Fueling An Epidemic Of Loneliness (6 min 44 sec)

  • Content Warning: homophobic language is used in this video as a descriptive
  • Goal: Introduce students to the concept of “Toxic Masculinity” and how it affects men’s health

As you watch the video, CONSIDER…

  1. How might this impact diagnosis and treatment of depression or other mental illness in adults and older adolescents in the primary care setting?
  2. Think about what you have learned in other EHM talks, and in your physiology courses.  How might this also impact the development of other illnesses such as cardiovascular disease?
  3. Suggested: Consider the research on social isolation among baby boomers. As adolescent and young men age, what might this mean for health status and care throughout the life course?

(2) READ: The XX & XY Lie: Our Social Construction of a Sex and Gender Binary (15 min)

  • Goal: Introduce students to the sex and gender binary, the concept of intersex, and definitions of trans/non-binary identities

As you read the article, CONSIDER…

  1. What is your gender identity? How do you know this about yourself? What does this identity mean to you?
  2. Imagine not being able to see your anatomy or chromosomal makeup. Pause and reflect on how this does and/or does not impact your identity?

(3) READ: I Was Pregnant and in Crisis. All the Doctors and Nurses Saw Was an Incompetent Black Woman (5 minutes)

  • Goal: Introduce students to biases experienced by women in clinical settings and allude to the idea of intersectionality (racism and sexism; “misogynoir”)

As you read the article, CONSIDER…

  1. Intersectionality is defined by sociologist and legal scholar Kimberlé Crenshaw as, “the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.” Recalling your sessions on race, how is intersectionality at play in this essay?

Part 2: Introduction to Social Determinants of Health

In this session, we will continue learning about the social determinants of health with a focus on social class and neighborhood effects. Students were introduced to social class/classism as a fundamental cause of health inequity in Week 1. This week, we expand on the SES-health relationship by describing what it is about social class that effects health both in relative and absolute terms. We also cover key aspects of environments and theories of how environmental conditions affect health. We close by offering anecdotes from faculty and community members on risk factors, protective factors, resilience, and prevention.

Optional activity:

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.

Improvement Methodology

Activity

These IHI modules are optional – IHI online open school.  Supplementary activity to provide greater detail and context for the material covered in lecture.  Recommended for students pursing a certificate in quality and safety. Improve understanding of aim statement by providing additional examples.

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

  • QI 102 Lessons 3, 4, and 5 (optional) – Identify steps in the model of improvement framework for choosing measures, developing changes, and testing changes.
    • These lessons will introduce the steps in the model of improvement framework by providing knowledge regarding types of quality measures, change concept tools for developing changes, and methodology for testing changes.
  • QI 103 Lesson 2 (optional) –  Discover how to use data to learn about the impact of changes.
    • These lessons will inform the student on the purpose of data and how data may be organized, examined, and presented using a run chart.
  • QI 103 Lesson 1 and 3 (optional) – Determine how to collect quality measurement data and how to learn from data.
    • These lessons describe the planning process, data sampling, scale, and scope in data management.
  • QI 104 Lessons 1-3 (optional) – Recognize the use of charting tools for interpretation of data.
    • These lessons expand on interpretation of data using run charts, control charts, and other measurements.

Conflict of interest

Activities:

  1. READ: Fromme E. Requests for Care from Family Members. Virtual Mentor.May 2012, Volume 14, Number 5: 368-372
    • Goal: Explain the ethical conflicts involved in deciding if and when to provide medical care for family members.
    • Instructions/context for reading:  Almost all medical students and physicians will receive requests for medical advice from family or friends at some point in their career. These requests can range from simple questions about routine medical care to complex inquiries about serious health issues or medications. Read this article about handling a request for medical care from a family member and consider how you might respond as a medical professional.
  1. READ: AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members.
    • Goal: Explain the implications of the policy statements from the AMA Board of Ethics and explore the ramifications of providing medical care for family and friends
    • Instructions/context for reading:  Responding to requests for medical care from family and friends in a manner that maintains professional integrity without compromising a personal relationship takes introspection and practice. Participating in class discussion will help students begin to analyze the nuances of these interactions and the ethical dilemmas involved in approaching requests from family and friends.

Optional readings: