- 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.
- Read over methods for responding to witnessed bias. Consider how you might respond as a bystander or the person receiving the bias.
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:
- VIEW “The Flint water crisis: A loss of trust” by CBS News (https://www.cbsnews.com/news/the-flint-water-crisis-a-loss-of-trust/)
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
- READ about the 2015 explosion in Tianjin, China and its implication for human health:
- 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.
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.
- 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…
- How might this impact diagnosis and treatment of depression or other mental illness in adults and older adolescents in the primary care setting?
- 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?
- 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…
- What is your gender identity? How do you know this about yourself? What does this identity mean to you?
- 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…
- 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?
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.
- READ: The Social Determinants of Health: Coming of Age.
- This review summarizes many social determinants that will be covered in the sessions this week in addition to many that we won’t get to dedicate time to
Molly Jackson, Elizabeth Kaplan
1) Read Article
GOAL: Appreciate the idea of aftermath of medical error and idea of provider as second victim..
Context and Instructions: Read article to begin to appreciate 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
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.
Assigned preclass video (15 min): Online video on Interprofessional Error Disclosure
IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx
- QI 105 Lessons 1-3
- QI 101 Lessons 1-3
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.
- 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.
- 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.