Three initiatives from NYU, Johns Hopkins, and Stanford aim at ensuring humanistic care for all
The Arnold P. Gold Foundation is pleased to announce the recipients of the 2021 Picker Gold Graduate Medical Education Challenge Grants, three exceptional projects designed to bolster the preparedness of clinical learning environments in caring for diverse family populations.
The newest Picker Gold initiatives are:
- Improving Maternal and Child Outcomes through Quality Perinatal Mental Healthcare led by Co-Principal Investigators, Jessica Vernon, MD, Assistant Professor at the NYU Grossman School of Medicine, and Olivia Myrick, MD, MHPE, Clinical Assistant Professor at the NYU Grossman School of Medicine and Associate Program Director for the NYU OB-GYN Residency Program. Drs. Vernon and Myrick will be developing and evaluating an evidence-based curriculum to equip OB-GYN trainees and junior faculty with the tools to screen and treat Perinatal Mood and Anxiety Disorders during pregnancy and the first year postpartum, an under-resourced area of mental health that affects up to 21% of women.
- Understanding the Family’s Perspective: Development of a Culturally Competent Curriculum to Increase the Acceptability of the COVID-19 Vaccine led by Principal Investigator Marquita Genies, MD, MPH, Assistant Professor of Pediatrics and Associate Residency Program Director, Department of Pediatrics at Johns Hopkins University School of Medicine. Dr. Genies and her team will be identifying the drivers of COVID-19 vaccine acceptability among parents-guardians in racial/ethnic minorities and underserved groups, which will inform a new educational curriculum of vaccine scripts and best practices in COVD-19 immunization counseling, as well as lead to national and international dissemination of the findings.
- Innovative Neonatal Health Disparities Curriculum for Pediatric Residents Informed by Qualitative Research and Community Engagement led by Principal Investigator Elizabeth Blecharczyk, MD, Clinical Assistant Professor of Pediatrics at Stanford University. She is a Neonatal Hospitalist at Lucile Packard Children’s Hospital Stanford. Dr. Blecharczyk and her team will be designing a pediatric resident curriculum that addresses the pernicious ripples of systematic bias and racism on neonatal patient outcomes and assesses pediatric trainees’ capacity to respond to these concerns in a clinical setting.
The Picker Gold Graduate Medical Education Challenge Grant Program supports the research and development of successful patient-centered care initiatives at residency programs and best practices in the education of our country’s physicians. Each Picker Gold award of up to $25,000 is matched by equal funding from the researchers’ medical institution.
“The Picker Gold GME Challenge Grants are a means of redefining what is possible in healthcare today. This Gold program supports faculty members in designing, evaluating, and ultimately disseminating far and wide new innovative, humanistic programs to help ensure complete and inclusive care,” said Elizabeth Cleek, PsyD, Gold Foundation Chief Operating Officer. “To put it simply, the undertakings of the Picker Gold researchers will help raise the standard of humanistic care and ensure that the oaths to compassionate patient care are as potent as ever.”
Improving Maternal and Child Outcomes through Quality Perinatal Mental Healthcare | New York University Langone Health
Drs. Vernon and Myrick have identified a critical need in OB-GYN care: Addressing Perinatal Mood and Anxiety Disorders (PMADS), a diverse spectrum of mental health disorders that occur during pregnancy and the first year postpartum, including depression, anxiety, obsessive compulsive disorder, bipolar disorder, post-traumatic stress disorder, and psychosis. Women experiencing PMADS face multiple barriers to care, including stigma; clinician knowledge gaps around diagnosis, treatment, and the emotional and social skills to engage patients in conversation around their mental health; and a lack of screening processes and workflow to easily identify and care for such patients.
Drs. Vernon and Myrick note that there currently exists no evidence-based education curriculum on PMADS for resident and faculty obstetricians – despite the fact that core competencies for residents include counseling patients and developing a plan for patients who have PMADs.
Thus, this Picker Gold project includes two components: (1) developing and implementing such an evidence-based PMADS curriculum for OB-GYN trainees and junior faculty, consisting of 10-part didactic series of 1-hour sessions and (2) assessing the real-world impact of the curriculum, including using pre and post surveys to determine trainee and faculty knowledge and confidence in triaging patients with PMADS, and using a focus group to draw out barriers and facilitators of the model.
The curriculum will be set up so it can easily be shared across the NYU health system, including within primary care settings, and be posted online for faculty development both at NYU and other institutions. Ultimately, the team hopes that by providing this training, they will empower OB-GYN staff with the expertise to independently manage straightforward mental health needs and identify where referrals are needed for more complex care. The group plans to create an interdisciplinary care model to streamline access to maternal mental health care, facilitating a patient-centered approach that will improve outcomes for new parents through a more cost-effective model.
In total, their Picker Gold project has the potential to dramatically improve humanistic care for new mothers and create a new generation of clinicians who will now be equipped to collaboratively better care for mothers’ mental health.
Understanding the Family’s Perspective: Development of a Culturally Competent Curriculum to Increase the Acceptability of the COVID-19 Vaccine | Johns Hopkins
COVID-19 has disproportionately affected racial/ ethnic minorities and underserved patients, both in number of cases and rate of deaths, which adds an urgency to ensuring these groups receive a protective COVID-19 vaccine. Many families are still deliberating about whether to give their children the vaccine. As of June 2021, when the COVID-19 vaccine was only available to children 12 and up, only 21.5% of those ages 12-15, 34.6% of those ages 16-17, and 39.5% of those ages 18-24 were fully vaccinated. Studies show that a pediatrician’s recommendation is a main predictor of vaccine acceptance, and effective counseling of families by pediatricians requires a deep understanding of the reasons behind the reluctance.
Seeking to both educate and innovate, Dr. Genies, co-investigator Dr. Jeffrey Fadrowski, and their team will conduct a mixed-methods study in the pursuit of a wider understanding of the blockades and stimulants of COVID-19 vaccination among parents-guardians of eligible children. They plan to use questionnaire surveys and semi-structured interviews to draw out the views of parents-guardians of children ages 2 to 18 years at a pediatric primary care clinic that is resident-run and cares for greater than 90% racial-ethnic minority children.
Their findings will inform the design of a COVID-19 vaccination curriculum, which will be disseminated and evaluated among 90 pediatric residents at the Johns Hopkins Hospital. The program will use vaccine scripts to make a positive case for COVID-19 vaccinations for children with emphasis on multiple humanistic aspects. This will include asking and showing respect for the parent/guardian/patient viewpoint, recognizing the influence that race-ethnicity can play in vaccine acceptability, and using evidence-based strategies to address vaccine deliberation. The COVID-19 vaccination rates at the clinic will ultimately be compared to the national average.
Dr. Genies’s Picker Gold research has the potential to illuminate the factors behind vaccine deliberation with the creation of new best practices for humanistic counseling around vaccinations – and ultimately could significantly bolster vaccination rates and improve the health of racial and ethnic minority populations.
Innovative Neonatal Health Disparities Curriculum for Pediatric Residents Informed by Qualitative Research and Community Engagement | Stanford University
The terrible impact of bias and systemic racism on neonatal patient outcomes has been studied and validated, with such significant findings as the mortality rate of non-Hispanic Black and Hispanic infants being 2.3 times the infant mortality rate of non-Hispanic white babies.
Yet, as Drs. Blecharczyk and her team members Drs. Shamita Punjabi, Rebecca Blankenburg, Christina Konecny, and Evangelina Molina point out, there has not been an assessment of how equipped pediatric trainees are to acknowledge and address these major concerns. Their Picker Gold project will probe this gap, ultimately leading to a new neonatal health disparities curriculum.
They will begin with a needs assessment of pediatric residents at three institutions (Stanford, UCSF, and Children’s Hospital Oakland) gathered from three focus groups, which will be recorded, transcribed verbatim and analyzed. From both the perspectives of the pediatric residents and the patient families, as well as iterative input from two community stakeholders, they will develop a four-week neonatal health disparities curriculum. Over a year, 39 pediatric interns will participate in the curriculum, which will be evaluated in pre/post surveys.
The curriculum will include requirement for trainees to communicate with a patient in their preferred language, using a certified interpreter since nursery patients often have a preferred language that is not English. The team hypothesizes that this low-effort and high-impact action will improve communication, especially during key transition times, which may lead to lower readmission rates.
The new curriculum will be made accessible to other residency programs via MedEdPortal or another open-source platform. In the long run, Drs. Blecharczyk and her team aim to ensure that any member of the interdisciplinary nursery team (including students, residents, fellows, nurse practitioners, allied health professionals and faculty) will be able to participate in this curriculum, helping deepen understanding of neonatal health disparities and create humanistic, equitable, just care for all infants and their families.