Race and Implicit Bias in the JeffMD Case-Based Learning Curriculum

Purpose: Race is related to health disparities, not to genetic predispositions, but race is often presented to medical students as a biological variable. At Sidney Kimmel Medical College, the curriculum has never been reviewed to analyze how race is presented to students. This Scholarly Inquiry project aims to analyze how the case-based learning (CBL) narratives presented to medical students perpetuate or challenge implicit biases in medicine, especially in regard to race. This paper will describe the methods of the project, which can serve as a model for other institutions to review their own curricula. Methods: Thirty-nine CBL cases from the 2018-2019 SKMC curriculum are being coded using the iterative process of directed content analysis. One of the two coders is a white medical student who has seen all of the cases in the classroom setting, and the other is a black doctoral student and adjunct faculty member in the College of Population Health who has never seen the cases before. The cases were imported into the qualitative analysis program NVivo, and each coder conducted line-by-line open-coding of seven different cases. From those cases, the coders developed a code book which includes definitions and examples of each code. Updates were made to the code book as more cases were coded and new topics emerged, and discrepancies were resolved by consensus. Using the final code book, all cases are now in the process of being double-coded (i.e. coded by each coder independently). Results and Conclusions: The coders aim to complete double-coding by the end of January 2020. At that point, the kappa value will be calculated to assess inter-coder reliability and codes will be organized into themes to write a results section. Already, we have noted the value of having at least one “case-naïve” coder and coders of different racial backgrounds, as many nuances of the cases were overlooked by the non-minority coder

Point-of-care versus central testing of hemoglobin during large volume blood transfusion.

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. RESULTS: Fifty one percent (86 of 170) of paired samples\u27 hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of - 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was \u3c 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. CONCLUSIONS: The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was \u3c 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is \u3c 7 g/dL until further prospective trials are performed in this population

A Systematic Review and Meta-analysis on the Effects of Culturally Tailored Group Diabetic Self-Management Education Programs Versus Usual Care on Hemoglobin A1c(HbA1c) and Health-related Quality of Life (HrQol) for African-American Adults with Type 2 Diabetes

For African-Americans, the burden of diabetes, diabetes-related conditions, and mortality is significant. Diabetic self-management education is an intervention used to increase knowledge, skill, and self-efficacy with diabetes self-care. Efforts have been made to establish culturally-adapted diabetic self-management education programs to improve health outcomes for African-Americans. However, research is limited with assessing their effectiveness. This systematic review and meta-analysis intends to evaluate the impact of existing culturally-tailored diabetic self-management education interventions on hemoglobin A1c and health-related quality of life for African-American adults with type 2 diabetes. Twelve randomized control trials comparing the effect of culturally tailored group diabetic self-management education programs versus usual care were selected for review. Seven trials contained data suitable for meta-analysis. Social determinants of health, including institutional racism, and critical race theory was used to provide context for the analysis. Results determine that existing culturally tailored programs have no impact on hemoglobin A1c and health-related quality of life when compared to usual care for African-American adults with type 2 diabetes. As there are no standards with determining the necessary components of a culturally appropriate intervention, many programs varied and subjective. Furthermore, most programs do not address social determinants of health, and are not comprehensive enough according to concepts of the critical race theory framework. Hence, additional research is needed concerning this subject which has important implications for both public and population health as it relates to historical and cultural competency as well as advocacy. Presentation: 21:0

Identification of Conceptual Domains Associated with Normalized Structural Racism in Healthcare Delivery that Contribute to Quality of Care Disparities Between Patients Racialized as Non-Hispanic Black/African American and Non-Hispanic White

Structural racism is a mechanism of intersecting components that reinforce inequity among racialized populations within various institutions, including health care. When entrenched at the system level, structural racism is believed to contribute to low quality of care for patients racialized as non-Hispanic Black/African American (NHB/AA) when compared to their counterparts who are racialized as non-Hispanic White (NHW). This study mapped the conceptual space of racism in healthcare delivery and explored how it is operationalized within related structures and processes that adversely impact quality of care. We employed group concept mapping (GCM) as a 3-step mixed method approach for collecting qualitative data and conducting quantitative analyses. Healthcare clinicians, researchers, and employee participants who self-identified as NHB/AA were recruited from Thomas Jefferson University Hospital and Vanderbilt University networks between May 2022 and March 2023. Recruited persons (n=15) participated in the first GCM step of brainstorming, n=16 completed the second step of sorting, and n=8 participated in the third step of rating. We identified eight conceptual domains of structural racism in healthcare delivery. All conceptual domains were identifiable and interpretable, suggesting that structural racism impacts quality of care. Results also revealed four new concepts not previously addressed in academic literature; one was determined as under-investigated. To our knowledge, this study is the first to employ GCM informed by critical race theory to create a conceptual map of structural racism at the system level of healthcare delivery. This data may be useful for expanding conceptual and theoretical research, policy assessment, interventions, and measurement tool development

The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis

Abstract Background Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care. Methods Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were reviewed, and 44 full-text articles were reviewed. Fourteen studies were eligible for systematic review and 8 for HbA1c meta-analysis; QOL measures were too heterogeneous to pool. Heterogeneity of HbA1c findings was assessed with Cochran’s Q and I 2. Results HbA1c weighted mean difference between intervention and usual care participants was not significant: − 0.08%[− 0.40–0.23];χ 2 = 84.79 (p < .001), I 2 = 92%, (n = 1630). Four of five studies measuring QOL reported significant improvements for intervention participants. Conclusions Meta-analysis results showed non-significant effect of DSME on HbA1c in African-Americans. QOL did show improvement and is an important DSME outcome to measure in future trials. Further research is needed to understand effectiveness of DSME on HbA1c in this population. Trial registration PROSPERO registration: CRD42017057282

Research in the DFCM

Objectives Scope of Family Medicine/Primary Care Research Overview of Departmental Research Infrastructure/research seminars/meetings Departmental Research Topic Areas How to get involved Research Website/IRB issues Research Fellowship Resident research lectures/curriculu

Additional file 2: of The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis

Risk of bias ratings for included studies. (DOC 46 kb

Additional file 1: of The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis

OVID Medline search strategy. (DOC 29 kb

Research in the DFCM

Objectives Scope of Family Medicine/Primary Care Research Overview of Departmental Research Infrastructure/research seminars/meetings Departmental Research Topic Areas How to get involved Research Website/IRB issues Research Fellowship Resident research lectures/curriculu