The Columbus Phenomenon: Prejudice And American Identity

For over 200 years, Columbus has been imbedded in American history and idealization. The mythology of Christopher Columbus in the United States has skewed public perspective, which is demonstrated by the disconnection between Columbus\u27s widely accepted tales of heroism and the true consequences of his voyage. The explorer has also been part of an ongoing quest for an American identity, spurred on and continually reshaped by the question, “what is an American?” To understand such a phenomenon, this paper examines how Columbus has been added and amended to the United States\u27 national narrative, from the eve of the American Revolution, to the era of Manifest Destiny, to the 1992 quincentennial of his voyage, and right up to his present day status. To address the emerging and diverging narratives of Columbus\u27s legacy, the role of immigration and influence of Italians and Catholics in the United States, as well as the U.S. Treatment of Native Americans, and how these ideals have been spread by individuals, media, and educational systems, are examined. In conclusion of this research, the Columbus mythology can be cited as one of the roots of racial tension inherent in American society, and is one of the moral and conceptual ideas behind the colonial actions the United States has taken both at home and abroad up until the present. The Columbus mythology will continue to play this role unless pro-colonial, Eurocentric, and white supremacist views can be maintained through mainstream government institutions

Does Peer Education Affect our Prescribing Practice? Impact of Educational Intervention on the Prescribing of Medication Assisted Treatment for Alcohol Use Disorder

BACKGROUND: Alcohol use disorders (AUD) are a common problem in the U.S and are associated with increased rates of early mortality and substantial morbidity. AUD and related complications are a common reason for ED visits, hospital admission, and readmission. Medication assisted treatment of AUD is effective, safe and evidence-based. Nationally and in New Mexico, effective treatment for AUD is underused. Numerous studies have demonstrated the utility of naltrexone and acamprosate, both FDA approved for the treatment of AUD. The hallmark meta-analysis highlighting the benefits of these medications was published in 2014 and there were multiple UNM hospitalist educational events on the treatment of AUDs starting in 2015. We aim to study the effect of these. METHODS: We compared the number of naltrexone and acamprosate prescriptions provided to patients discharged from an adult internal medicine hospitalist service over the course of a 5 year period beginning in 2014, and each subsequent year as measured via EMR queries. Peer education on best practices in the treatment of AUDs attended by UNM hospitalists and trainees included grand rounds, hospital medicine Best Practices didactics, Hospitalist Training Track didactics, journal article review, and professional society meetings. A handout was developed and disseminating explaining these medications including their indications, risks, and benefits. RESULTS: Prescriptions for naltrexone and acamprosate increased from 1-2 per quarter to up to 28 per quarter. CONCLUSION: The number of naltrexone and acamprosate prescriptions increased over the designated 5-year period in direct correlation with educational interventions, although absolute numbers were low. This helps demonstrate the importance of continued education regarding best practices for treating AUDs, while also highlighting limitations and opportunities for hard-wiring processes to improve prescription rates

Developing a Structured Training on Responding to Discrimination from Patients

Discrimination against clinicians is increasingly common. Few educational opportunities exist on how to respond to discrimination from patients and visitors. The authors developed and presented an interactive training on this problem, potential strategies for how to respond, and creating solutions. During an educational meeting, faculty presented a video about Times Up Healthcare then participants read a JAMA article about discrimination and the need for allies to speak up. Participants then engaged in think-pair-share on the article and experiences with speaking up. Next, faculty presented a peer-reviewed journal article on a qualitative analysis of semi-structured interviews that provides a framework for responding to discrimination from patients. Using guidance from existing literature, potential approaches for addressing the problem were presented. These included strategies for faculty, trainee, and frontline clinician development and institutional involvement. Next, participants read another JAMA article on calling-out inappropriate behavior that includes recommending being prepared for how to respond to discrimination and then performed think–pair–share on the article with discussion prompts. The session concluded with solicitation of best next steps, and the group developed a task force that would champion training for faculty and learners, measure how often the problem occurs in the institution, and develop policy and education on escalation/the chain of command. Lessons learned and next steps: (a) There is a need for training on responding to discrimination from patients and visitors. Faculty and trainees can lead education and empower others through sharing informational materials. (b) Future directions include studying the effects of these efforts on implementing a process, policy, and training for responding to discrimination. (c) Education Day participants can use and adapt these materials to conduct trainings in their environment

Gender Differences in Internal Medicine Grand Rounds - Speakers at a Local Academic Hospital

Despite increasing numbers of female medical students and junior physicians in America, women are still underrepresented in leadership in medicine. Many theories have been proposed to explain this, and gender bias has been shown to be a contributing factor. Within academic hospitals, grand rounds provides an opportunity for dissemination of clinical knowledge. Exposure to female presenters is thus critical to allow for female trainees to establish relationships and witness role modeling opportunities. The aim of this study is to assess whether gender differences exist in Internal Medicine grand rounds presenters at an academic hospital. We hypothesize that the proportion of women speakers will represent less than 50% of all presenters and will not represent their proportion in the physician population. We analyzed gender differences in presenters over 4.5 years. Female presenters were compared with male presenters via a one-tailed t-test, and with population female physicians via binomial analysis. Overall, there was an increasing number of female presenters over 4.5 years. The percent of female presenters was significantly lower than male presenters for all years except 2018. When controlling for the population proportion of female physicians, the results were statistically insignificant. In conclusion, academic centers should be encouraged to equally invite male and female colleagues to present at grand rounds. Female physicians should also be encouraged to embrace these opportunities, and serve as role models and mentors to junior faculty, while also potentially contributing to the retention of female physicians in academic medicine

Facilitating a Resident-Run Journal Club: Fostering Autonomy within a Time-Honored Tradition

Journal club is a time club is a time-honored tradition in medicine, and participation can increase knowledge and critical appraisal skills in trainees. Given the rapid pace at which medical knowledge changes, journal club can also help physicians keep abreast of current innovations. Best practices have been proposed for journal club, although UNM medical educators report variable attendance and engagement at journal club, and UNM trainees report varying relevance of journal club. Additionally, semi-structured peer interactions can decrease professional isolation and burnout

COVID-19 vaccine hesitancy and attitude toward booster doses among US healthcare workers

Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18-40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required; however, vaccine-hesitant respondents\u27 acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported; the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination

Mechanisms That Promote and Support Family Preservation for Children at the Edge of Care: A Realist Synthesis

Children in care of the state are amongst the most disadvantaged in society. They have often experienced adverse childhood experiences leading to their care entry including abuse and neglect. Longitudinal data suggests problems children in care of the state experience within adolescence persist into adulthood, showing “a continuing legacy of adversity.” Emerging literature shows that edge of care interventions can bring about benefits. These interventions support families to meet their child’s needs and prevent, or reduce, the likelihood of children going into care. However, it is not clear how or why these interventions work. It is important to develop this understanding to inform the development of effective, theory-informed practice to benefit this population. We reviewed and synthesised published literature to expose mechanisms by which interventions may promote and support family preservation for children at the edge of care. Our synthesis uses a realist approach to examine mechanisms by which interventions, in various contexts, can promote and support family preservation for children at the edge of care. Previous work by the team shaped the initial search strategy and in line with RAMESES realist review guidelines, no restrictions were placed on the types of study to be included in the synthesis. From 7,530 potentially relevant references identified, 61 papers were included in final extraction. Extracted data was themed, prior to developing narrative and formulating programme theories. Effective edge of care service operation seemed to be based on four core programme theories pertaining to the need for family skills training, home-based delivery, dedicated worker, and rapid response to need

Bundling socio-technical innovations to empower women as partners and drivers of climate change solutions

The CGIAR Initiative on Gender Equality (HER+: Harnessing Gender and Social Equality for Resilience in Agri-food systems) aims to achieve climate resilience by strengthening gender equality and social inclusion across food systems in the Global South. Together with partners, the initiative supports women to increase their agency and to acquire and gain control over resources. The initiative facilitates women’s pathways to empowerment and helps them adapt to future climate-related shocks and stresses. The initiative addresses four areas of gender inequality in the AFS: access to resources, women’s agency, social norms and policies, and governance. The work in these four areas is divided into four work packages. This workshop is part of Work Package 2. This work package aims to achieve climate resilience by strengthening gender equality and social inclusion across food systems in the Global South. We develop and test context-specific bundles of social and technological innovations with the aim increasing adoption and benefits for women in agri- food systems. As a part of this work, the IIED developed a draft framework based on the STIBs concept. The framework links access to productive technologies, resources, and services to achieving healthy, equitable, resilient, and sustainable (HERS) outcomes for farmers (Barrett, 2022). It has a strong focus on gender and empowerment. The framework was developed from a literature review of studies and reports that discussed gender, technology, resilience, climate smart agriculture, and documented outcomes. The team used a realist synthesis methodology to unpack the contexts, mechanisms for change, and the outcomes from the studies identified. The IIED team then interviewed experts who later suggested adjustments based on their experience. In the workshop, the IIED team shared the draft framework with participants who included researchers and practitioners in the agricultural research for development sector. They then sought feedback from participants to fine-tune and validate the framework. IIED also tested the application of this framework to specific projects, selecting context-specific interventions to build suitable STIBs that generate better outcomes and broader impacts. The framework will support the implementation of the learning labs in different agro-ecological and socio-cultural contexts across Africa and Asia