Following is a sampling of articles related to diversity, equity, inclusion and antiracism (DEIAR) and healthcare.
Do you know of an article that addresses health equity or DEIAR work that can be shared with the Gold community? Please share a resource here.
Disparities in Unilateral Do Not Resuscitate Order Use During the COVID-19 Pandemic Piscitello GM, Tyker A, Schenker Y, Arnold RM, Siegler M, Parker WF. Crit Care Med. 2023 Aug 1;51(8):1012-1022. doi: 10.1097/CCM.0000000000005863. Epub 2023 Mar 30. PMID: 36995088. Dr. Robert M. Arnold has been a Gold Foundation grantee
The implementation of unilateral Do Not Resuscitate (UDNR) orders, where the decision to withhold resuscitation is made by a clinician without requiring consent from the patient or surrogate, presents an ethical dilemma, especially during the COVID-19 pandemic. To understand the application of UDNR orders, Dr. Gina M. Piscitello and colleagues conducted a retrospective cohort study of 1,473 ICU patients with a high severity of illness (requiring vasopressors or inotropes agents) in two Chicago-area hospitals during the first pandemic surge between March 1, 2020, and April 30, 2020. The authors discovered that UDNR orders were used in 3% of the patients. Patients whose primary language was Spanish were 4 times more likely to receive a UNDR order than others and patients whose race was identified as Black were twice as likely. The study adds to literature identifying disparities in care among speakers of languages other than English and is the first to describe this in the setting of UNDR orders. The authors speculate that these disparities may be a result of communication barriers but more research is warranted to definitely identify root causes for these disparities.
This article was featured in the Jeffrey Silver Humanism in Healthcare Research Roundup which offers summaries of recently published studies on humanism in healthcare.
University of Pittsburgh Nursing School Creates Tools and Learning for LGBTQIA+ Healthcare. The article profiles the work of Drs. Brenda Cassidy, Betty Braxter, and Andrea Fischl to develop an interactive learning module and resource toolbox to promote best practices in LGBTQIA+ healthcare, which is now available to students and all healthcare providers. Currently, fewer than 20% of nursing students are prepared to provide care for LGBTQIA+ patients. Issues connected to unconscious bias are explored.
Asian American doctors, overrepresented in medicine, are largely left out of leadership (Stat News)
Here’s a short excerpt, but the entire piece is full of stats and worth reading.
He [orthopedic surgeon Charles S. Day] found that white doctors were more than four times as likely as their Asian American colleagues to be promoted to medical school department chair positions in a wide array of medical specialties, and that Black and brown doctors were more than twice as likely as Asians to be promoted.
In 2019, according to a new analysis by Day, Asian Americans made up 13% of orthopedics faculty at U.S. medical schools but held just 5% of chairs. When Day looked across a range of specialties, including family medicine and OB-GYN, he found that Asian American physicians held more than 20% of faculty positions but less than 11% of chair positions. He also found near complete silence about this leadership gap.
The issue remains largely invisible because Asian Americans are considered overrepresented in medicine: They make up just 7% of the nation’s population but are 20% of its doctors. Asian Americans also are often considered the “model minority” — statistics show that as a group they tend to be healthier, wealthier, and more educated than other racial groups, including white Americans. As a result, the progress and challenges of Asian Americans in medicine have been little studied or discussed.
Throughout the 20th century, US public health and immigration policies intersected with and informed one another in the country’s response to Mexican immigration. Three historical episodes illustrate how perceived racial differences influenced disease diagnosis: a 1916 typhus outbreak, the midcentury Bracero Program, and medical deportations that are taking place today. Disease, or just the threat of it, marked Mexicans as foreign, just as much as phenotype, native language, accent, or clothing. A focus on race rendered other factors and structures, such as poor working conditions or structural inequalities in health care, invisible. This attitude had long-term effects on immigration policy, as well as on how Mexicans were received in the United States.
https://pubmed.ncbi.nlm.nih.gov/21493932/
Molina N. Borders, laborers, and racialized medicalization Mexican immigration and US public health practices in the 20th century. Am J Public Health. 2011 Jun;101(6):1024-31. doi: 10.2105/AJPH.2010.300056. Epub 2011 Apr 14. PMID: 21493932; PMCID: PMC3093266.
The Accreditation Council for Graduate Medical Education (ACGME) has recently introduced disability-focused regulations, emphasizing disability as a key component of diversity, equity, and inclusion efforts in medical training. However, compliance with these requirements remains low, and stigmatizing attitudes toward disability persist in the medical field. To understand the barriers to disability disclosure and accommodation requests among resident physicians, Dr. Karina Pereira-Lima and colleagues conducted a cross-sectional survey. In June 2022, they surveyed 1,162 first-year resident physicians across the United States, assessing the frequency of disability reporting and requests for accommodations. The authors found that a significant number of residents did not request accommodations when needed, often due to fear of stigma or bias, lack of a clear institutional process for requesting accommodations, or lack of documentation to support the accommodation request. According to the authors, these findings underscore the urgent need for medical programs to commit to ACGME compliance and design policies that include clear processes for requesting accommodations
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804787 (JAMA Network Open)
This article was featured in the Jeffrey Silver Humanism in Healthcare Research Roundup, a newsletter from the Gold Foundation that offers summaries of recently published studies on humanism in healthcare.
A recent report, Reshaping the Journey: American Indians and Alaska Natives in Medicine, released by the Association of American Indian Physicians and the AAMC, brings attention to the lack of American Indian and Alaska Native representation in medicine. Learn more about the report’s findings, programs to support American Indian and Alaska Native students, and the importance of increasing diversity and inclusion in medicine.
The Journal of Medical Internet Research present the Women in Medicine and Science special e-collection, which is dedicated to highlighting the inequities that exist in communities and health care systems. Many articles relate to issues concerning well-being, including as addressing caregiving fatigue.
The publication of this e-collection of invited papers is in partnership with The Women in Medicine Summit, a conference designed to amplify the lives of women physicians, practitioners, researchers, and academics in medicine and work towards gender parity in healthcare through skills development, action plans, advocacy, professional growth, education, allyship, empowerment, and inspiration.
Dismantling Structural Racism free online course. Designed by Gold Course Directors Ruth S. Shim, MD, MPH, and Karinn Glover, MD, MPH, in collaboration with the NextGenU.org team and sponsored by The Gold Foundation, this open access professional development course helps healthcare leaders to develop an action plan for their institution, including identifying steps towards dismantling structural racism. The course modules include several helpful articles relating to this content.
ShareTools is a free resource to support health professions educators seeking to integrate humanities-based, anti-racism education for their learners. This resource leverages the power of the health humanities as a pedagogical tool, providing a comprehensive facilitator’s guide, detailed instructions for implementing curricular modules, an image library, and a collection of relevant music. Modules cover a variety of topics relevant to reflection, conversation, and action around racism, and draw upon a number of disciplines, including art, literature, anthropology, and the history of medicine.
The course modules cite articles relating to the content.
This 2022 article highlights the first study to look closely at Gold Humanism Honor Society membership in medical schools across four categories – race/ethnicity, sex, sexual orientation, and childhood family income – found selection into GHHS was no less or more likely for students in most marginalized groups, a rarity for prestigious medical accomplishments.
Read the article here. For more insights, read this Q&A with the study authors.
This article offers a profile of Dr. Louis Sullivan, the Founding Dean and President Emeritus of the Morehouse School of Medicine and former U.S. Secretary of Health and Human Services. Dr. Sullivan received the 2023 National Humanism in Medicine Medal from the Gold Foundation.